Gastric bypass surgery has evolved over the past 60 years, with an estimated 220,000 gastric bypass procedures performed in the U.S. in 2008. Refinement has brought a decrease in mortality rates. A study release July 30, 2009, in the "New England Journal of Medicine" found 30-day for patients who had Roux-en-Y gastric bypass or laparoscopic adjustable gastric banding to be 0.3 percent, no riskier than gallbladder or hip replacement surgery.
Malabsorptive Procedures
The first bariatric surgery was performed by Drs. Kremen, Linder and Nelson at the University of Minnesota in 1954. This jejunoileal bypass eliminated a large portion of the intestines, creating significant malabsorption. At abound the same time in Sweden, Dr. Victor Henriksson performed a similar procedure. These early procedures were refined during the next 15 years, but complications were significant and these highly malabsorptive procedures have been all but abandoned. More recently it has been discovered that Dr. Richard Varco also performed a JIB procedure at a University of Minnesota facility about the same time as Dr. Kremen.
Restrictive Procedures
The first restrictive surgical procedure was performed by Dr. Edward E. Mason at the University of Iowa. The horizontal gastroplasty divided the stomach into two compartments. Refinements to improve weight loss resulted in the vertical banded gastroplasty, still in use today. The first gastric bands were used in the 1970s but lack of adjustability rendered them ineffective. The advent of the adjustable gastric band in 1986 significantly improved the outcome, and variations of this procedure remain in use.
Combined Procedures
Drs. Mason and Ito are credited with performing the first gastric bypass in 1967. This seminal work became the foundation for the Roux-en-Y gastric bypass. Using staples, Dr. Mason gave patients a small pouch with which to eat, crafted from the most durable section of the stomach to minimize stretching. The new pouch and the remainder of the stomach were reconnected to the small intestines, bypassing a portion. This procedure in essence combined the best of both restrictive and malabsorptive techniques, providing a safe and effective treatment still used widely today. Further refinements have allowed this surgery to be performed laparoscopically, providing a continued reduction in risk.
What's Next
Gastric stimulation implants are being evaluated as are intragastric balloons, inserted into the stomach and then filled with fluid to reduce consumption. For the heaviest patients, staged procedures are being explored to allow more controlled weight loss. This process uses a series of procedures in combination to minimize the risk to the patient.
Significance
Gastric bypass surgery has improved the quality of life for hundreds of thousands of people since its inception. Recent research has validated its potential to cure or improve a variety of serious health issues including diabetes, asthma and high blood pressure. About 25 percent of individuals attending bariatric surgery information sessions go on to have the surgery. Continued research, refinements and education will enable a portion of the remaining 75 percent to gain the same benefits.
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