Abstracto

An overview of Bariatric Surgery to the present

Mervyn Deitel

With increasing high-caloric fast-food and sedentary lifestyle, worldwide obesity has been increasing for the past 50 years. For morbid obesity in the 1970s, jejunoileal bypass (JIB) developed as a malabsorptive operation; JIB had specific complications which tied down the surgeon. The horizontal loop gastric bypass of Mason became preferred; because tension on the loop anastomosis had potential for leak, gastric bypass was changed to a Rouxen-Y configuration (RYGB), which has been performed extensively. Gastroplasties developed as restrictive operations in the 1980s, initially horizontal, followed by vertical banded gastroplasty (VBG). In 1983, the American Society for Bariatric Surgery (ASBS) was formed at a meeting in Iowa, and has vastly enlarged. In 1991, I started publishing the Obesity Surgery journalas Editor-in-Chief, which became the official journal of IFSO, and rapidly progressed to high ranking. In the 1990s, the adjustable gastric band (AGB) was placed to restrict the very proximal stomach (connected by tubing to a subcutaneous reservoir), and the AGB was suitable as a laparoscopic operation. Subsequently, all bariatric operations have been able to be performedlaparoscopically. In 2000, sleeve gastrectomy (the first part of the DS alone) developedas a stand-alone operation, but dissection at the cardiahas led to devastating leaks plus GE reflux and occasional Barrett’s esophagus. TheMini-Gastric Bypass (MGB), as well as its One Anastomosis Gastric Bypass (OAGB) variant,with a long sleeve anastomosed antecolicas a wide gastrojejunostomyat ~200cm has gained remarkable popularity, as a simple malabsorptiveoperation, effectively reversing the co-morbidities of morbid obesity. Postop nutritional requirements must be followed.Type 2 diabetesusually resolves after MGB-OAGB and is being