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Weight Loss Surgery (Obesity Surgery) - History & Review
 Jejuno-Ilieal Bypass Surgery
Biliopancreatic Diversion (BPD) Gastric Bypass
Biliopancreative Diversion and Duodenal Switch
Gastric
Banding
Roux-en-Y Gastric Bypass
Weight loss surgery has become popular with the obvious failure of
non-operative means to produce permanent weight loss in morbidly obese
patients. The concept of weight loss surgery was first introduced
in the 1950’s 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 1960's and early 1970's, Jejuno-Ileal Bypass (JIB) was
shown to produce permanent weight reduction and became the most popular
weight loss surgery. 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 weight loss surgery fell into disrepute.
Biliopancreatic Diversion (BPD) Gastric Bypass
The multiple complications associated with JIB weight loss surgery
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 weight loss surgery 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. |
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Obesity Surgery Center
1250 Jesse Jewell Parkway
Suite 300
Gainesville, Georgia 30501
Toll Free: 877-921-0110
Fax: 770-534-2555 |
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