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
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)
|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, 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.