Obesity and the health problems associated with it have been around for centuries. However, the field of bariatric medicine is relatively new, dating back about 70 years. During this time, medical and technological advancements have led to effective and safe methods of various types of bariatric surgery.
In what follows, we will discuss the history of bariatric surgery and its different milestones that have led to today’s medical advances on bariatric medicine. If you’re interested in knowing more about any of the procedures you’re about to read, please contact our practice located in Tijuana, Mexico.
10th century: Defeat obesity to regain the throne
Historical reports from the 10th century claim that it was the king of Leon, D. Sancho, who had the very first “bariatric surgery”. According to these claims, his obesity made it difficult for him to walk, ride a horse, and pick up his sword; as a result, he lost his throne. He was later intervened by a Jewish doctor named Hasdai Ibn Shaprut, in Cordoba, Spain, who sutured king of Leon’s lips together, only leaving a small opening in the center. This way, the king could only be fed a liquid diet of herbs through a straw. The king Sancho quickly lost half of his body weight, returned to Leon, and regained his throne [1]. What a wonderful success story, right?
1954: the first jejuno-ileal bypass
The latter was supposedly the first medical intervention that attempted to promote significant weight loss. However, many years passed before the medical community started developing serious methods to defeat obesity and achieve weight loss.
It was in 1954 that the first, let’s say “modern”, bariatric surgery was performed: John Linner, under the tutelage of Richard L. Varco and supervision of Owen H. Wangensteen, practiced the first jejuno-ileal bypass in a canine model. This procedure was one in which most of the small intestine was bypassed. The intervention was so masterfully done that it was presented in the American Surgical Spring Meeting of that same year [2]. That presentation later inspired other surgeons to practice and perfect the same technique.
60’s: the once famous jejunoileal bypass
During the 60’s, an interdisciplinary team lead by a surgeon, a gastroenterologist, and a pathologist, inspired by Linner’s method, conducted a large study where they intervened ten patients by performing end-to-side jejunocolic shunts. It was the surgeon of this team, Payne, who first coined the term “morbid obesity” to encourage insurance companies to pay for this type of surgeries. Weight loss occurred in all the patients of the study, but most of them regained their weight and needed a revision of their surgery.
The team then modified the technique so they could leave a reasonable amount of jejunum and a smaller portion of the ileum in continuity with the ingested food.
This led to a longer-term maintenance of the weight loss. So, the 60’s decade was witness of a higher number of patients receiving either jejunoileal or jejunocolic shunts that were progressively perfectioned. However, the complications that derived from these procedures were also very high: some patients experienced liver failure, malnutrition, vitamin deficiencies, malabsorption, kidney stones, ketosis, hyperoxaluria, etc [2].
These were different times
Back then, most doctors were not interested in treating obesity. Bariatric surgery was seen as a medical practice performed by a group of surgical renegades who could be attending “real” problems and diseases. Obesity was not recognized as a health condition but as the outcome of bad life choices, gluttony and sloth. This mindset lead to discrimination against obese patients and lack of support and resources for bariatric surgeons. It was much, much later that the medical and surgical community discovered obesity’s relation with other comorbidities like diabetes.
1967: the origin of the gastric bypass
Another major breakthrough happened in1966, when Dr. Edward E. Mason, a surgeon from the University of Iowa, noticed that his cancer patients who had a sub-total gastrectomy lost a considerable amount of weight with success.
He soon proposed the first gastric bypass through a horizontal cut across the stomach with a loop that diverts the bile from the stomach and esophagus [1]. It became the surgical standard across the medical community. Mason continued perfecting the procedure for the next years.
He later modified the technique by placing an end-to-end anastomosis stapler through the stomach and placing a piece of Marlex mesh through the hole and back through an aperture at the lesser curvature of the stomach. This vertical banded gastroplasty became very popular in the early 80s and was the most popular bariatric surgery in the United States [2].
1977: jaw wiring
In 1977, jaw wiring was being tested to treat obesity as another type of bariatric surgery. That year, there were 17 cases published. The weight loss was successful and comparable to gastric bypass, but once the wires were removed, the patients regained the weight [1].
1979: the biliopancreatic diversion
In 1979, Nicola Scopirano performed an operation that he later called the biliopancreatic diversion. He reported excellent weight loss results that also required long-term follow-up on order to prevent any malnutrition or mineral deficiencies [2].
1986: the origin of the gastric band
Bypass surgery was still a viable option as doctors continued to test and improve their techniques. In 1986, L, Kuzmak invented a silastic ring with a small balloon embedded on the inner aspect of the ring that could be accessed from a subcutaneously placed reservoir [2]. This became the origin of the adjustable gastric band. This method was very successful for several years, as restrictive bariatric surgeries produced greater results and had less complications.
Bariatric surgeries then were very benefited from the technological advances regarding surgical tools, specially staplers.
1987: the origin of the gastric sleeve
In 1987, Johnston performed a procedure that was later perfectioned into the now well-known gastric sleeve. The gastric sleeve had previously been used as a part of a more complex procedure, the duodenal switch. With this innovation, the gastric sleeve later became a stand-alone procedure.
1993: the emergence of laparoscopic procedures
Up until now, and still many years later, every bariatric surgery was performed by opening the patient with an incision in the abdomen, intervening, and then suturing the wound with stitches. However, major advances in technology, especially digital imaging and very small cameras, allowed surgeons to engage in less invasive interventions. In October 1993, Wittgrove and Clark performed the first laparoscopic gastric bypass in the United States [2]. The first successful laparoscopic banding procedure also happened during that year and it was performed by Broadbent [2]. Other surgeons and other bariatric surgeries started following these examples.
The development of laparoscopic surgery improved the safety of bariatric procedures. For instance, the operative mortality rate lowered to less than 0.2%, and the complication rate fell to only a third of the complications coming from open procedures. Also, hospital stays went from 3 to 5 days to only 2 days, and patients had faster recoveries [2]. All these factors contributed to lowering the cost of bariatric surgeries and making them more accessible and affordable, both for surgeons and patients.
1995: a great finding about the Roux-en-Y gastric bypass
MacDonald and Pories were the first surgeons that showed that the Roux-en-Y gastric bypass had very positive effects on patients with type II diabetes [2]. Although the medical community knew that weight loss improved insulin resistance and glucose metabolism, bariatric surgery was not recognized as a viable treatment for diabetes. Even back in 1995, this finding didn’t catch much attention among general doctors.
1998: obesity is seen as a public health problem
As mentioned before, obesity used to be seen as an annoyance caused by poor life choices and there was much prejudice towards people struggling with obesity and morbid obesity. Furthermore, most bariatric surgeries were not seen as medical interventions, but almost as esthetic remedies. This type of idea might be the reason why most medical insurance didn’t cover these types of procedures.
But all this started changing once the World Health Organization recognized obesity and morbid obesity as a disease in 1998 [3]. It also acknowledged it as a public health issue of dangerous proportions and consequences. Nowadays, obesity is seen as a systemic problem that doesn’t fall solely on people’s choices, but in many other factors regarding genetics, health conditions, medication use, culture, economy, and so much more. The recognition of these issues has also led most medical insurance to start covering major bariatric surgeries such as the gastric bypass and the gastric sleeve.
This is interesting because it shows us that bariatric surgery has not only benefited from technological advances and medical innovations, but also from public policy and cultural changes throughout the years.
Today
Weight loss surgery has become more common as obesity has reached its highest peaks. As such, bariatric surgery is nowadays recognized as the most efficient treatment for obesity among the medical and surgical community. According to the American Society for Metabolic and Bariatric Surgery, from 2011 to 2019, surgeons have performed more than 1,851,000 bariatric surgeries, only in the United States [4]; and countless more are performed worldwide. This has helped decrease the risks of many life-threatening diseases, such as type two diabetes, heart disease, stroke, and cancer.
Nowadays, most bariatric surgeries are done with laparoscopic techniques. The most popular bariatric surgery is, by far, the gastric sleeve. More than half of the world’s bariatric surgeries account for this type of surgery [5]. The second most popular is the gastric bypass.
Contact Us Today
At LIMARP International Center of Excellence for obesity, we offer an integral bariatric program that includes a medical intervention (either surgical or non-surgical), nutritional guidance, psychological counselling, a personalized fitness routine, and long-term follow up. We also offer all-inclusive packages for patients that visit us from abroad; these include transportation and hotel reservations. Our main surgeon and CEO, Dr. María Liza Pompa González, has the surgical skills, certifications, and designations that make her a leader in her field and a great choice for your bariatric surgery. Contact us online today to schedule your consultation. Our team of experts will be very glad to help.
References
[1] G. R. Faria, “A brief history of bariatric surgery,” Porto Biomed. J., vol. 2, no. 3, pp. 90–92, May 2017, doi: 10.1016/j.pbj.2017.01.008.
[2] E. Chousleb, J. A. Rodriguez, and P. O’Leary, “History of the Development of Metabolic/Bariatric Surgery,” in The ASMBS Textbook of Bariatric Surgery, 2nd ed., Springer, pp. 37–46.
[3] F. Arrieta and J. Pedro-Botet, “Recognizing obesity as a disease: A true challenge,” Rev. Clin. Esp., May 2021, doi: 10.1016/j.rceng.2020.08.005.
[4] “Estimate of Bariatric Surgery Numbers, 2011-2019,” American Society for Metabolic and Bariatric Surgery, Mar. 08, 2021. https://asmbs.org/resources/estimate-of-bariatric-surgery-numbers (accessed Feb. 11, 2022).
[5] W. A. Brown et al., “IFSO & Dendrite Clinical Systems,” p. 104.