The Evolution of Bariatric Surgery (it’s so cool)

The Evolution of Bariatric Surgery

The search for the ideal weight loss operation began more than 60 years ago. Dr Viktor Henrikson of Sweden can be credited as the first surgeon to perform metabolic surgery that induced both weight loss and treated metabolic comorbidities.

That’s because bariatric surgery is a truly a hormonal and metabolic procedure. While weight loss does happen through restriction and malabsorptive processes, it is the rebalancing of appetite hormones that drives both weight loss and the improvement of metabolic comorbidities.

Among patients with type 2 diabetes, for example, did you know that they are able to come off their type 2 diabetes medications before they have lost any weight? Sometimes, that’s before hospital discharge. Bariatric surgery is a metabolic surgery. By virtue of altering the anatomy of the gastrointestinal tract, there is an inherent increase in fullness hormones and decrease in hunger hormones that works to re-set metabolism.

Bariatric surgery is the ultimate hormone re-set treatment that is currently available.

Dr. Henrikson’s 1952 case report on the procedure described a resection a 105-cm segment of small bowel in a 32-year-old woman suffering from obesity, constipation, slowed metabolism, and the inability to complete a weight loss program successfully.

The idea for the procedure apparently came to him after becoming aware of a couple of reported cases in which “favorable side-effects concerning weight and intestinal function occurred” after small bowel resection for the treatment of ulcers.

Another breakthrough happened in 1966, when Dr. Edward E. Mason, a surgeon from the University of Iowa, noticed his cancer patients losing a considerable amount of weight with success following a sub-total gastrectomy.

One year later he proposed the first Roux-en-Y Gastric Bypass through a horizontal cut across the stomach with a loop that diverts the bile from the stomach and esophagus. This became the surgical standard across the medical community.

The Gastric Bypass continues to be the standard of care for metabolic surgery today.

In 1987, the first gastric sleeve was performed. Notable for removing 80% of the stomach, it is now well-known as the Vertical Gastric Sleeve (VGS). The VGS has became a stand-alone procedure and the most popular procedure among patients today.

By 1993, things went laparoscopic (video-guided and no cutting open the abdomen)! After the first gastric bypass surgery was performed in the United States, other surgeons started following this example.

In 1995, we discovered that the Roux-en-Y Gastric bypass reversed type 2 diabetes…

We currently have a cure for type 2 diabetes—it’s called the Roux-en-Y Gastric Bypass.

But no one ever talks about bariatric surgery as an option to cure type 2 diabetes and bariatric surgery remained in obscurity until two things happened:

  1. Obesity became recognized as a disease state by the World Health Organization in 1998 that can lead to life-threatening comorbidities such as diabetes, hypertension, sleep apnea, dyslipidemia, venous stasis with a higher risk for premature death.
  • Obesity became an epidemic.

The biggest attention grabber of all happened in 2002 when Al Roker, of NBC’s The Today Show, underwent gastric bypass and lost over 100 pounds. After Al Roker’s success, the bariatric- surgery saw a 40% increase in the number of surgeries completed from the year prior.

Metabolic bariatric surgery is the most effective treatment for obesity today.

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