Obesity has been part of the human condition since the beginning of time, however a spike in the prevalence started to take place after the revolution in farming, with the addition of preservatives to maximize shellfire of food, emergence of fast food and sedentarism, all this gave way to the increase prevalence of obesity throughout the world.

There have been a number of procedures that have been performed throughout the history of weight loss surgery, all of them with the same purpose; to reduce the burden of body fat  in a person’s body and improve their health. However, not all of them have withstood the test of time. Some of them have shown us to be very aggressive and carry a lot of postoperative risks and some others have not shown to have the effectiveness we hoped for, also, these long road of trial and error has given us a lot of knowledge , and that knowledge has given us the ability to develop the procedures we now perform with very low risk and with very good results.

The first investigation by Linner of the effects of bypassing part of the intestines  to get to know the changes that could do on canine model was presented at the American Surgical Spring Meeting in 1954,[1].

Based on this result  Payne, De Wind, and Commons performed an en to side jejunocolic shunt in ten patients [2].Weight loss occurred in each of the patients the protocol included reestablishment of continuity of the intestine, after which all patients regained their previous weight. In a later publication Payne and DeWind reported acceptable weight loss results in a large number of patients [3]. Also there where some complications secondary to these operations such as fatty liver. Malnutrition, renal stones, electrolyte anormalities, migratory arthralgia,vitamin deficiencies, etc. and it was felt the risk benefit ratio was too high to recommend routine use. There was no appreciation that obesity was a disease and that is was intimately associated with diabetes, cardiovascular disease, and even certain types of cancer, there was a failure to associate the proinflamatory state that obesity induced in every organ and system in the body.

In 1967 Mason reported a procedure named jejunoileal bypass in patients with duodenal ulcer and obesity [4].this is the first approach to a gastric bypass for the treatment of morbid obesity, he then later published alterations to this procedure. Alden did another modification to this procedure giving birth to the first Gastric Bypass en Y of Roux which is the essence of the gastric bypass surgery we now know,[5]. In 1986 L. Kuzmak Invented a silastic ring that embedded a balloon on the inner space, that was access from a subcutaneous reservoir and the Lap Band was born. This allowed calibration of the inner lumen [6].

In Europe Nicolas Scopinaro developed a surgery termed biliopancreatic diversion (BPD)  which consisted of resecting great part o the stomach, dividing the small bowel and unite it to the stomach resected, the remaining small bowel carrying pancreatic enzymes and bile was anastomosed or united at a distal part causing malabsortion. He reported excellent weight loss results at a cost of mineral deficiencies and and absorption of fat soluble vitamin, he reported also that with adequate followup these side effects could be managed properly and without any long term complications [7].In the decade of the 90’s also Mcdonald and Pories Published the beneficial effects of bariatric surgery on patients with type II diabetes it was named “who would have thought it? An operation proves proves to be the most effective therapy for adult onset diabetes mellitus.[8]. This was well received in the bariatric surgery community and Schauer also published similar results in 2003[9]. After that A summit in Rome was attended by large  number of scientific organizations and a consensus was published, the term Metabolic surgery was resurfaced explaining that weight loss surgery had significant good impact and even resolution of metabolic diseases such as diabetes.

In 1991 The National Institutes of Health NIH found that Weight Loss Surgery ameliorated many diseases associated with obesity and formally recommended this surgery for the treatment of morbid obesity and its associated comorbidities (diseases). Also in the 90’s Laparoscopic or minimally invasive surgery emerged as a safer option to obese patients, diminishing morbimortality dramatically and making these type of surgeries extremely safe in experienced hands.

The first Laparoscopic bypass surgery was performed by Wittgrove and Clark in 1993.

The fist Laparoscopic Band placement was performed by Broadbent also in 1993.

In 1986 Hess and Hess did a modification of Scopinaro’s BPD and did a vertical gastrectomy and duodeno-yeyunal anastomosis to avoid some of the side effects of the more aggressive BPD. And in 1999 the first Laparoscopic Duodenal Switch was performed by Res and Gagner. This is the first time a sleeve gastrectomy was performed as part of a  more complex surgery. Later in 2008 the indications for sleeve gastrectomy for a stand alone procedure where published and since then gastric sleeve has gain vast popularity due to it’s simplicity, costs, low risks and good results.

After al this procedure another ones have arise, to later prove themselves not to be as effective as the ones we already have, such as gastric plication, it once had surgeons and patients exited about having a restrictive procedure with the same effects as the gastric sleeve but without having to “cut” the stomach, later on we would see the long terms results where not as we thought they would and abandon this procedure. Mini gastric bypass has been emerging as a good and not too invasive alternative with promising results, but time will give us the last word. What we now know for sure is that weight loss surgery has become the most effective treatment so far for obesity and diabetes along with the other constituents of the metabolic syndrome, such as high blood cholesterol, triglycerides, sleep apnea and other.

Who would have though that a surgery would cure diabetes?

1.Kremen AJ, Linner JH,Nelson CH. An experimental evaluation of nutrition importance of proximal and distal small intestine. Ann Sure. 1954;140:439.

2. Payne JH,DeWind LT, Commons RR, Metabolic observations in patients with jejunocolic shunts.Am J Surg. 1963;106:273.

3. Payne JJ, DeWind LT, Surgical Treatment in Obesity.Am J Surg. 1969;118:141.

4. Mason EE, Ito C Gastric Bypass in obesit. Sure Clin North Am. 1967;47:1345.

5. Alden JF,Gastric and jejunoileal bypass, Arch Surg.1977;112:799-806.

6. Kuzmak L. Silicone gastric banding.a simple and effective operation for morbid obesity. Comtem Surf 1986;28:13-8

7. Scopinaro N, Adam GF, MarinariGM, Biliopancreatic Diversion World J Surg; 1998;22:936-46.

8. Pories WJ,Swanson MS, McDonald KG, Long SB, Morris PG, Brown BM, et al, Who would have though it?An operation proves proves to be the most effective therapy for adult onset diabetes mellitus;Ann Surg.1995;222:339-52.

9.Schauer PR, Burguera B, Ikrammudin S, Cottam D, Gourash W, Hammad G, et al, Effect of laparoscopic roux en Y gastric bypass on type 2 diabetes mellitus.Ann Surg 2003;238:(4):467-85.

Dr. Galileo Villarreal

Bariatric Surgeon