Bariatrics originated in 1965 and is rooted in the Greek words; “bar” (weight), “iatr” (treatment/surgery), and “ic” (having characteristics of). Gastrointestinal surgery procedures like standalone sleeve gastrectomy, RNY gastric bypass, and duodenal switch (BPD/DS) collectively comprise bariatric and metabolic surgery.
Endobariatrics: Non-surgical weight loss therapies such as gastric balloon and endoscopic sleeve gastroplasty (ESG) are newer approaches to help overweight patients.
Surgical changes to the stomach and digestive tract limit the amount of food you can eat, alter gut hormones (reduce hunger), improve satiety and absorb fewer calories. Bariatrics is a practical and potent approach versus conventional treatments to achieve sustainable weight reduction and resolve morbidities, such as cardiovascular problems, diabetes, hypertension, sleep apnea, and asthma.
Evolution of Bariatric Surgery
Treatment of Obesity in the 10th Century
Historians report that the Spanish king of Leon, Sancho I (932-966), was the first patient known to be treated for obesity. Nicknamed “the Fat,” he was so huge he could not walk or pick up a sword. As a result, Sancho I lost his throne.
Sancho I was attended by a Jewish physician, Hasday Ibn Shaprut, who authored the first anti-obesity diet plan. Dr. Shaprut sewed up the overthrown king’s lips so tight that he could only drink liquid with a straw. That made him lose half of his weight and be able to reclaim his crown.
History of Gastric Bypass
Swiss surgeon Dr. Cesar Roux carried out the first gastric bypass in 1892 to treat the patient’s digestive obstruction. Dr. Roux abandoned this surgical procedure in 1911 due to high mortality rates and peptic ulcerations. Modification to this method to become today’s RNY Gastric Bypass, including the addition of jejunocolic shunt.
Progression of Medical Discipline
Year 1954 - Jejunoileal Bypass (JIB)
In the 1950s, the medical industry brought bariatric surgery into the market, with the Jejunoileal Bypass (JIB). This was the first type of bariatrics operation where a large part of the intestine is bypassed, while the stomach stays intact. Although weight loss was enough, it caused severe complications due to permanent malabsorption. Patients would encounter diarrhea, night blindness, osteoporosis, liver disease, and liver failure.
Year 1966 - Open Gastric Bypass Surgery (RNY)
This lead to the Open Gastric Bypass in 1966, which is similar to the laparoscopic gastric bypass but instead the entire abdominal cavity is cut open for better access for surgeons.
Year 1970 - Open Gastroplasty and Vertical Banded Gastroplasty
In 1970, Open Gastroplasty was invented, splitting the stomach into two sections. 10 years later, in 1980, the open gastroplasty led to the Vertical Banded Gastroplasty.
In 1978, the Gastric Band, or LAP-BAND, was created. This procedure places a band around the stomach to reduce its size.
Year 1986 - Duodenal Switch Surgery (DS)
Less than a decade later, the biliopancreatic diversion with a duodenal switch, called Duodenal Switch for short, began, where the stomach size is reduced while the small intestines are bypassed.
Year 1994 - Laparoscopic Gastric Bypass (Roux-en-Y)
In 1994 the Laparoscopic Gastric Bypass started as surgeons gained more experience with open gastric bypass. RNY gastric bypass procedure is one of the most popular bariatric surgeries today.
Year 1997 - Open Gastric Sleeve (Sleeve Gastrectomy)
The Open Gastric Sleeve, or Vertical Sleeve Gastrectomy (VSG), was created in 1997. This procedure removes up to 80% of the stomach. The first open gastric sleeve operation in Ohio, U.S. was performed by Doug Hess in 1988 as the first part of the duodenal switch procedure.
Year 2000 - Laparoscopic Gastric Sleeve Surgery (Sleeve Gastrectomy)
3 years later in 2000, the open gastric sleeve became the Laparoscopic Gastric Sleeve, needing only 5 incisions to complete the procedure. Gastric sleeve in Mexico is a pioneer in the world.
Year 2015 - Gastric Band (Lap Band) FDA Approved
Obesity Pandemic
Growing in exponential proportion, obesity poses serious health risks and fatality worldwide. COVID-19 shed a light on the obesity problem worldwide as Coronavirus attacks fat cells.
Body Mass Index, or BMI, is a conventional measurement used to calculate body fat percentage based on a person’s height and weight.
Bariatric surgery facilitates dramatic and durable weight reduction when diet and exercise are unproductive. Gastrointestinal operations have shown to increase patients’ median life expectancy by over 9 years.
The Mechanics of Bariatric Surgery
Long-term weight control is largely attributed to the alteration of gastrointestinal hormone levels that are responsible for hunger and satiety, fundamentally leading to a new metabolic set point.
Bariatric weight loss surgery encompasses specialized laparoscopic, open-incision, and endoscopic techniques performed on overweight, obese, or morbidly obese people.
Number of Bariatric Surgeries (2011 to 2019) | |||||||||
|---|---|---|---|---|---|---|---|---|---|
| 2011 | 2012 | 2013 | 2014 | 2015 | 2016 | 2017 | 2018 | 2019* | |
| Total | 158,000 | 173,000 | 179,000 | 193,000 | 196,000 | 216,000 | 228,000 | 252,000 | 256,000 |
| Gastric Sleeve (VSG) | 28,124 | 57,090 | 75,359 | 99,781 | 105,056 | 125,496 | 135,432 | 154,728 | 152,064 |
| Gastric Bypass (Roux-en-Y) | 57,986 | 64,875 | 61,218 | 51,724 | 45,080 | 40,392 | 40,584 | 42,840 | 45,568 |
| Gastric Banding (LAP-BAND) | 55,932 | 34,946 | 25,060 | 18,335 | 11,172 | 7,344 | 6,156 | 2,772 | 2,304 |
| Duodenal Switch (BPD/DS) | 1,422 | 1,730 | 1,790 | 772 | 1,176 | 1,296 | 1,596 | 2,016 | 2,304 |
| Revision Surgery | 9,480 | 10,380 | 10,740 | 22,195 | 26,656 | 30,240 | 32,148 | 38,808 | 42,752 |
| Other | 5,056 | 3,979 | 4,833 | 193 | 6,272 | 5,616 | 5,700 | 5,796 | 6,144 |
| Gastric Balloon System | — | — | — | — | 588 | 5,616 | 6,384 | 5,040 | 4,608 |
*Source: ASMBS – American Society of Bariatric and Metabolic Surgeries
The Future of Bariatric Surgery
Weight loss surgery has been reported to improve patient’s quality of life, psychological relief, and mental health. Mortality rates are negatively correlated with obesity. The underlying medical comorbidities are studied to be highly effective by significantly reducing risk factors for obese individuals.
Gastric bypass and other weight-loss surgeries like vertical sleeve gastrectomy – performed mainly laparoscopically — have proven themselves to be of great value to super obese. The future direction of bariatric surgery is Robotics and Endoscopic operations.
Robotic laparoscopic bariatric surgery
Robotics is also minimally invasive as being tested and implemented to become mainstream. Natural Orifice Transluminal Endoscopic Surgery (NOTES) and Laparoendoscopic Single-Site (or LESS) Surgery are evolving robotic techniques.
Endoscopic procedures
Endoscopic procedures, like Endoscopic Sleeve Gastroplasty (ESG) and Transoral Outlet Reduction (TORe), are considered a less invasive approach. Endobariatrics are taking their place as an alternative to laparoscopic operations, but they are limited to lower BMIs and specific revisions.