Ooh get me!
Actually that title is WAY above my meagre pay grade and brain power so today I thought I would let you in something I was interested to find out myself the other day.
The History of Bariatric Surgery – it may surprise, well it did me anyway… 😉
Before that though, I feel I must address a small issue of what is what in the world of Bariatrics. I still get surprised looks from people when they hear exactly what I have had done even though I am sure I have gone over my procedure several times already! The following is a list of available regular procedures, a quick description then a link to what exactly each one is and does. Do follow the links because they really are very interesting.
Just as a spoiler alert, this post today is a touch more cerebral than usual so if you are suffering their effects of a heavy night, perhaps come back to it a bit later when the old grey matter is working clearly…
The following explanations and graphics are taken from the Covidien Website
This procedure involves surgery on the stomach only (it is a restrictive procedure). It consists of making a stomach that looks like a pouch before surgery into a long tube, or “sleeve.” The sleeve gastrectomy procedure removes approximately two-thirds of the stomach. After the procedure, the stomach is about the size and shape of a banana and resembles a sleeve. The smaller stomach restricts food intake by allowing only a small amount of food to be consumed in a single sitting, providing a quicker sense of fullness and decreased appetite.
The sleeve gastrectomy is believed to have an advantage over the adjustable gastric band due to removal of the part of the stomach that produces the hormone (ghrelin) that controls the desire to eat.
Why Choose Sleeve Gastrectomy?
- It does not require the implantation of a foreign body such as a band used in gastric banding
- The procedure mechanically decreases the size of the stomach but also decreases the secretion of the hormone ghrelin, which is responsible for the feeling of satiety (fullness)
- The procedure offers the benefit of initially decreasing the body weight in the severely obese patient to prepare this patient for a staged procedure or other surgery at a later time
Roux-en-Y Gastric Bypass was developed to restrict the amount of food and limit absorption. This surgical procedure converts the stomach to a small pouch that holds approximately 2 ounces of food. The gastric bypass procedure then routes food past most of the stomach and first part of the small intestine. In addition to restricting food intake, a Roux-en-Y Gastric Bypass reduces nutrient absorption.
This surgery limits the amount of food that can be eaten, yet leaves the patient feeling full and satisfied on very little food. Having less food naturally results in reduced caloric intake, and weight loss usually follows. With Roux-en-Y Gastric Bypass, risks for nutritional deficiencies are higher than restrictive procedures (bypass causes food to skip the duodenum, where most iron and calcium are absorbed).
Why Choose Roux-en-Y Gastric Bypass?
- The procedure results in early sense of fullness and satisfaction, thus reducing the desire to eat
- A common benefit is greater weight loss
- There is less long-term maintenance than gastric banding (no band fills needed)
- There is reduced chance to “cheat” the surgery compared with gastric banding
This procedure utilizes an adjustable band that is placed at the top of the stomach to create a small pouch. With its reduced size, this pouch provides a sense of satiety after a very small meal. The band can be adjusted to increase or decrease the restricted area of the stomach through a port. The opening to the rest of the digestive tract is adjustable through an epidermal port.
Weight loss is slower than alternative weight loss procedures, but with appropriate aftercare and routine band adjustments, it has been shown to ultimately result in comparable long-term weight loss 3 or 4 years after bariatric surgery. Risks associated with adjustable gastric banding include band erosion or slippage, equipment malfunction, or infection.
Why Choose Adjustable Gastric Banding?
- The small pouch makes you feel full after limited food
- There are no vitamin or mineral deficiencies due to malabsorption
- The procedure is less invasive and reversible
- This procedure offers more flexibility through the adjustable feature
Now for that history lesson I promised you guys….
Over 60 years ago now, Kremen (not the Captain in a Kenny Everett sketch) and Associates performed the first bariatric procedure in 1954. It involved anastomosis (joining together) of the upper and lower intestine, which bypasses a large amount of the absorptive circuit. Later in 1963 Payne-DeWind developed something called the end-to-end Jejuno-colic Shunt (decreases intestinal absorption, especially fats) which connected the upper small intestine to the colon. This was followed by the Jejuno-ileal bypass (removing and setting to one side all but 18″ of the small intestine, which is over 20 feet long!) which did work but the side effects were many with patients experiencing uncontrollable diarrhoea caused by immune deficiencies and also arthritis-dermatitis causing septic inflammations in the upper joints. Eventually the procedure was converted to side-to-side anastomosis to alleviate symptoms. Modifications to the procedure included the 1973 Scott-Dean technique of bypassing smaller lengths of small intestine, but again this led to severe diarrhea, dehydration and a third of patients developing hepatic cirrhosis (all not really very good…)
Not really a great start so in the 50’s, 60’s and 70’s, I imagine you would have been healthier being overweight without doing these dreadful things to yourself. Still this is the nature of science and vanity. I do recall my Doctor and I discussing surgery about 10 years ago saying that although at the time I did not qualify so it was a moot point, it was still relatively untested for longevity and how the body dealt with prolonged nutritional issues -still the cause for that came later.
In 1967 the Gastric Bypass was introduced which led to fewer complications than the intestinal bypass although there were still issues until 1996 when Scopinaro-Gianetta developed this procedure into what is now one of the most common procedures: The Roux-en-Y Gastric Bypass – a limited gastrectomy with a short common alimentary canal. This procedure produces significant malabsorption, but long-term studies demonstrate 72 percent of excess weight loss maintained over an 18-year observation. The addition of a Duodenal Switch (a very rare procedure) by Hess-Marceau in 1992-1993 eliminated stomach ulcers and dumping syndrome (still an issue with RYGB and VGS)
It is known that Mal-absorbtive (RYGB) procedures produce greater sustained weight loss with less dietary compliance, but pose an increased risk of malnutrition, vitamin deficiency and intermittent diarrhea, and require constant follow up to monitor increased risk unlike the Vertical Gastric Sleeve procedure which is a purely restrictive procedure, meaning there is no intestinal bypass. It may also have a “resective” or “reductive” quality in that a large portion of the stomach is removed, which may facilitate gastric emptying and favourably alter duodenal and ileal gut hormones. The gastric reduction may also reduce the amount of ghrelin and related hormones that are released, which may also provide a hormonal advantage to help reduce caloric intake.
The history of the sleeve gastrectomy is more an evolution of prior procedures than a direct timeline of development of a single procedure. The procedure has its roots in the earliest gastroplasty procedures and as an observation from prior anti-reflux procedures. It was Doug Hess, in Bowling Green, Ohio, who performed the first open (as in they cut you open!) sleeve gastrectomy in March of 1988.
Today, they no longer cut you open for any of the three procedures, simply relying on the Laparoscopic technology we now have available to us. This means that the patient heals much quicker and better than before as there are no major areas for infection due to them being spread over the surface of the abdomen. Obviously it means that the patient is up and about much more quickly and is no longer convalescing for such a lengthy time thus reducing their exposure to harmful germs that make their way around the hospital wards.
To be honest, I must be thankful for all that have gone before me and all of the trials and errors that were made in the name of science. I am very lucky to be living in this time as so far to date there have been no ill effects related to my surgery and I am feeling healthier and happier than I have in long many a year. This feeling will only get better because very soon I will go back the the surgeon (this Tuesday) at what will be a mere 4 weeks and 4 days after my surgery and hopefully I will be told I can start back at the gym undertaking some lightweight training and general “getting back in the swing of things”!
History eh? You’ve got to love it, it’s not just how things happened but it also how we got to now… 😉
Stay out of the fridge