FROM BYPASS TO BALLOONS: THE EVOLUTION OF BARIATRIC SURGERY
Derek Benham*, Gordon Wisbach, Romeo Ignacio
General Surgery, Naval Medical Center San Diego, San Diego, CA
Dr. JH Payne was the first to publish on the surgical treatment of obesity utilizing a jejunocolic bypass in 1963. Since then, surgeons have strived to find the balance between optimizing weight loss and control of comorbidities. The jejunocolic bypass was known as a purely malabsorptive process, but it was fraught with severe complications. Therefore in 1969, Payne recommended a jejunoileostomy, and many patients who previously had undergone a jejunocolic bypass were revised.
In 1979, Dr. Scopinaro first described a modified bypass procedure, the biliopancreatic diversion. This was a combination of previously described jejunoileal bypass with a restriction of the gastric pouch. This procedure was further modified by adding a pylorus-sparing procedure to decrease the rates of postgastrectomy syndrome, the duodenal switch. However with the development of gastric bypass, this procedure has fallen out of favor.
Meanwhile in Iowa, Dr. Edward Mason considered the Father of Bariatric surgery started to perform gastric bypass surgery as a weight reduction procedure in 1966. He isolated a portion of the stomach, and created a retrocolic gastrojejunostomy, with a noncutting stapler. This procedure was further altered in 1977 by Dr. Griffin, with the advent of the Roux limb, leading to the Roux-en-Y gastric bypass, which has become the gold standard for weight loss procedures in the United States.
Dr. Mason furthered the science of bariatric surgery with his work on gastroplasty. Starting with horizontal gastroplasty which left a small orifice for outflow of gastric contents, he further developed the vertical banded gastroplasty. The purely restrictive procedures saw great utilization in the 1980s-90s that later progressed to the adjustable gastric band. The principals applied to the purely restrictive procedures led to the development of the sleeve gastrectomy in 1988 by Dr. Hess.
The advent of minimally invasive surgery has significantly altered the landscape of bariatric surgery. The first description of laparoscopic gastric bypass in 1994, by Dr. Alan Wittgrove. Since that day, laparoscopic and robotic surgery has seen a reduction in surgical complications, shorter hospitalizations, and improved outcomes.
More recently, an endoscopic method of restriction has been developed. Endoscopic placement of intragastric balloons have been placed for short term weight loss and have been found to be safe alternative which may signal the next era in bariatric surgery.
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