Home > Obesity
Surgery > Procedure & Techniques
Obesity Surgery Overview & History
Obesity surgery has become popular
with the obvious failure of non-operative means to produce permanent
weight loss in morbidly obese patients. The concept of surgical
weight loss was first introduced in the 1950s and has continually
evolved since its inception. From dangerous overly-malabsorptive
early procedures to today's gold standard of the Roux-en-Y gastric
bypass, surgeons have spent decades fine-tuning obesity surgery
to the point of being able to offer truly successful results and
truly healthy lives to their patients.
Jejuno-Ilieal Bypass Surgery
In the late 1960s and
early 1970s, Jejuno-Ilieal Bypass (JIB) was shown to produce permanent
weight reduction and became the most popular operation for weight
loss. It involved joining the upper small intestine to the lower
part of the small intestine and bypassing a large segment of the
small bowel which was taken out of the nutrient absorptive circuit.
However, long term observation revealed many complications and this
particular method of surgical weight loss fell into disrepute.
Biliopancreatic Diversion (BPD) Gastric Bypass
The multiple complications associated with JIB led to a search for
alternative procedures, one of which was gastric bypass surgery.
Biliopancreatic Diversion (BPD) is a more modern obesity surgery
in which no small intestine is defunctionalized and consequently
many problems that plagued JIB patients occur less frequently.
This procedure has two components, a limited gastrectomy to reduce
food intake and construction of a long Y limb with a short common
channel to create a significant malabsorptive component.
Biliopancreative Diversion and Duodenal Switch
In the 1980s a combination of the Biliopancreative Diversion and
the Duodenal Switch was developed as a version of obesity surgery
with the advantages of the BPD but without some of the associated
malabsorptive problems. Known as the BPDDS, this operation and its
variants are the most major obesity surgeries and carry the associated
risks of complicated operations.
Gastric Banding
In Vertical Banded Gastroplasty (VBG), the most common solely restrictive
weight loss surgery, both a band and staples are used to create
the small stomach pouch.
In Adjustable Gastric Banding (AGB), a hollow adjustable band made
of special material is placed around the stomach to create a half-ounce
pouch and the band is then inflated with a saline solution. The
pouch's outlet size can be adjusted by injecting saline into a small
port placed under the skin at the time of the weight loss surgery
and connected to the band by I.V. tubing. In both methods of gastric
banding there is the need for strict patient compliance since there
is nothing about this form of weight loss surgery that limits what
patients can eat – even high caloric foods lacking nutritional
value.
Roux-en-Y Gastric Bypass
Modifications and improvements have led to today's "gold standard"
of obesity surgery – the Roux-en-Y gastric bypass - in which
the stomach is cut into two parts. The upper pouch, which becomes
the working stomach, is only about the size of a man's thumb at
the time of surgery. The larger lower portion of the stomach never
holds food again, but does aid in the digestive process. A new intestinal
limb is brought up to the new stomach pouch, connecting it to the
intestines.
The complications of gastric bypass surgery are much less severe
than those of intestinal bypass surgeries and are usually easily
handled by a competent medical staff and patient compliance.
Surgeons can perform gastric bypass laparoscopically in patients
who are appropriate candidates and as the procedures for obesity
surgery themselves have evolved, so has aftercare and long-term
follow-up.
|
