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History of Weight Loss Surgery
Weight loss surgery has gained in popularity in recent years. I beleive that much of this is fueled by the “Extreme Makeover” reality shows and famous celebrities such as Al Roker undergoing the knife.
While bariatric surgery, isn’t bad in itself, it would be great if many people would just not have to go down this path. It seems that people all over America getting increasingly fatter every year and therefore having to have various forms of weight loss surgery procedures to help them lose the excess fat. Looking the history of it all, we essentially start just after WWII in the 1950s.
What Exactly Was The Year of The First Weight Loss Surgery?
In 1954, the world was intorduced to the first weight loss surgery known to mankind by Dr. A. J. Kremen. He did what he called an “intestinal bypass.” As the name implies, a section of the intestine was bypassed by connecting upper and lower areas of the intestines.
His surgery was essentually a jejunoileal bypass procedure. This took out a good part of the middle section of the intestines and the hope was to reduce the amount of food absorbed. It worked, but encountered many complications such as electrolyte imbalances, dehydration, bypass enteritis, diarrhea, long-term liver problems, and various vitamin and mineral deficiencies. The problems were so bad that there was a 50% mortality rate.
The reason they experimented in this way with the digestive system was because of medical observations of patients that had short-bowel syndrome. Peopel with this condition had a tendency to lose weight due to inadequate nutrient absorption. Based on these observations, surgeon A.J. Kremen, MD, started the medical field of bariatric surgery (although it was not named that until later).
At about the same time in Sweden, a physician did a similar procedure, but he removed the redundant portion of the small intestine. Throughout the 50s and 60s, there many experimental operations that were tested by physicians on morbidly obese patients. Eventually, intestinal modification was abandoned for the most part, and weight loss surguries involving the stomach in some form or fashion became more prevalent.
1966 – The Start of The Gastric Bypass Era
In 1966, Dr. Edward E. Mason of the University of Iowa began work on developing an innovative bariatric surgery known as gastric bypass, also called stomach stapling or vertical banded gastroplasty. In the gastric bypass surgery, he isolated a section of the upper stomach by using staples to partition the stomach and decreasing the volume of food it can hold.
In effect, he was creating a smaller pouch of a stomach for the stomach that satiated the obese person faster during meals, therefore decreasing food consumption.
As with any new medical innovation, there were improvements that had to be made to refine the process following the initial procedures. As time went by, the complications became less and less (although even today there are chances of morbidity) More refinements such as reducing the pouch size and eventually changing from metal staples to elastic bands. The main problem with elastic was that he bands began to stretch after a few years. This particualr surgery is not done very much now.
Roux-en-Y Gastric Bypass (Proximal)
This form of gastric bypass is by far the most commonly used gastric bypass technique today in the United States and around the world. This form of weight loss is the least likely to have nutritional problems occur. The small intestine at the base of the stomach is cut and rerouted in a Y shape connecting to the upper pouch created in the stomach through what is referred to as a Roux limb. The Roux limb is a section of 30-60 inches of the upper intestine, which still allows for plenty of nutrient absorption. Due to less complications, it is one of the most common weight loss surgery procedures of today.
Today’s Bariatric Advances
Today, there are about eight different varaitions of bariatric surgery performed in the United States most state-of-the-art hospitals across the United States. One of the latest is the Lap band technology that forms a ring around the stomach and is adjustable by saline solution. As bariatric medicine advances, the furture for the morbidly obese is looking much brighter.
Medical References:
Kremen, AJ, Linner JH, et al. An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann Surg 1954;140:439-48.
American Society for Metabolic & Bariatric Surgery
Mason EE, Ito C: Gastric bypass. Ann Surg 170:329, 1969
