The history of bariatric surgery is relatively short, highly productive, imaginative, and one with tremendous impact on the history of surgery, the development of laparoscopic surgery, and the world epidemic of morbid obesity.
This history extends only slightly longer than 50 years in duration, a post–World War II phenomenon of the late twentieth century. During these 50 years, over 50 operations, or variations of operations, have been proposed to manage morbid obesity. These procedures have involved inducing malabsorption, restricting consumption, combinations of malabsorption and restriction, electrical stimulation, gastric balloons, and extra-gastrointestinal innovations. The nuances proposed within these broad categories are a testimonial to the varied, and often convoluted, thought processes of surgeons and other pioneers in obesity therapy.
There have been few, if any, surgical applications that have so radically changed the field of surgery as has bariatric surgery. From an obscure procedure occasionally performed, often derided by other physicians and even surgeons, bariatric surgery has come to dominate general surgery. In many hospitals and specialty centers, bariatric surgery is the most common class of operations being performed. As laparoscopic techniques have been applied to more and more procedures, nowhere has laparoscopy become more prevalent than in bariatric surgery. This development of laparoscopic bariatric surgery has impacted hospitals and device manufacturers, all eager to offer up-to-date laparoscopic operating room suites, laparoscopic instrumentation, and robotics.
At the turn of the twenty-first century, overweight (body mass index (BMI) ≥ 25 kg/m2) is a world epidemic involving nearly two billion people, including nearly two-thirds of US citizens, of whom 50–60 million are obese (BMI ≥ 30 kg/m2) and about 10 million are morbidly obese (BMI ≥ 40 or ≥ 35 with significant comorbidities). This epidemic of obesity affects one out of every four adults in the United States and one out of every five children. The comorbid conditions of morbid obesity are responsible for a decrease in life expectancy of about 9 years in women and of about 12 years in men. Unfortunately, long-term weight loss results with diet therapy, with and without support organizations, has failed in the treatment of this disease. There are currently no truly effective pharmaceutical agents to treat obesity, especially morbid obesity. Bariatric surgery today is the treatment of choice and the only effective therapy in the management of morbid obesity. It is, therefore, incumbent on every surgeon, in particular the bariatric surgeon, as well as the rest of the medical profession, and, to some extent, private and government health-care providers, the public, especially the obese public, to have knowledge of the evolution of surgical procedures for morbid obesity.
Previous publications have traced this history in a linear thematic manner—i.e., the history of malabsorptive procedures, malabsorptive/restrictive procedures, purely restrictive procedures, and other procedures (Figure 1–1).1 This chapter will look at the bariatric surgery innovations over the past 50 years in cross-section, or horizontally, by decade, in ...