The history of metabolic surgery for morbid obesity and a commentary

Abstract

This paper serves as an introduction to a symposium on “Surgical Treatment of Morbid Obesity.” It offers a brief historical review of the antecedents for and the operative interventions in this field of metabolic surgery. In essence, the procedures can be divided between jejunoileal operations and their derivatives, and gastric operations. The jejunoileal bypasses originated with end‐to‐end jejunoileostomy; deviated to end‐to‐side jejunocolic, jejunocecal, and finally jejunoileal bypasses; and returned to end‐to‐end jejunoileal bypasses with different lengths of functioning bowel and various sites for colonic drainage of the bypassed bowel. More recently, pancreatic‐biliary‐intestinal bypass operations have been proposed. The gastric operations can be separated into gastric bypasses with closure of the fundic pouch and anastomosis to a segment of small intestine; gastroplasty with separation of the stomach into a small upper pouch communicating via a limiting orifice to the remainder of the stomach; and gastric partitioning, the simplest variation of gastroplasty, consisting of a cross‐stapling of the stomach with omission of several central staples. Finally, vagotomy alone has been advocated. We must conclude with the commentary that there is no optimal operation in this field, but that we need not apologize for an “85% cure rate.” What we must work toward in the future is the development of therapy based not on circumvention but on an understanding of the satiety factor.

Laparoscopic adjustable gastric banding with truncal vagotomy: any increased weight loss?

“…Mason first proposed purely restrictive gastric procedures in 1971 as a safer alternative to gastric bypass [7]. Several incarnations of gastroplasty were performed, but none was as effective as a gastric bypass.…”

Effect of Roux-en-Y Gastric Bypass Surgery on Bile Acid Metabolism in Normal and Obese Diabetic Rats

“…The World Health Organisation estimates that 500 million people worldwide will suffer from T2DM by 2050 and describes the rise of such chronic non-communicable diseases as an ‘impending disaster’ ( http://www.who.int/mediacentre/news/releases/2011/ncds_20110427/en/ ). Rapid and sustained improvements in glucose homeostasis following bariatric operations have led to their classification as metabolic procedures and gold standard treatments for diabetic subjects with significant obesity (BMI>35kg/m 2 ) [ 1 , 2 ]. The mechanisms of post-operative T2DM remission can be divided into weight loss-dependent and independent pathways.…”

Une première chirurgie de l’obésité : la longue controverse du court-circuit jéjuno-iléal (1954-1980)

“…C'est depuis cette retraite que Buchwald se mit à planter, sans détour, les limites à l'intérieur desquelles il désirait recadrer le débat sur la pertinence clinique de la chirurgie d'obésité : « Therapeutic innovations are the result of serendipity or de novo reasoning, either of which requires exhaustive knowledge of available data, clear perception of the imaginable implications, and commitment to objective clinical appraisal ». 109 S'il précisait bien sa pensée, c'était toutefois d'une manière qui ouvrait la voie à toutes sortes d'interprétations : « An innovator in metabolic surgery, i.e., the operative manipulation of a normal organ or organ system to achieve a biological result for a potential health gain, must not only be bold but must also exhibit a social conscience ». 110 Un tel appel à la conscience sociale des chirurgiens se voulait résolument bivalent.…”