The History of Weight Loss Surgery

I originally began this topic as a reply to another poster on another thread. It seems to be an area of some confusion, so I thought I'd post my findings as a new topic here as well. I thought this would be a fairly simple undertaking, but I found that neither the pages I was citing, nor some of the other posters citations were entirely correct. There is a large degree of ambiguity and excessive 'lumping of terms' that made looking up specific surgeons and dates very difficult; however after extensive reading, research, and the purchase of several 'pay per view' medical studies/reports, I have established the best timeline of surgeries based off the information currently available to me. If others have updates, reference pages or additional information to add, please feel free as I wanted to condense volumes of information contained on numerous websites, PDFs, and medical journals into one post as clearly this is an area of some confusion. This has nothing to do with which surgery is best as I have always been and always will be an advocate of choosing the surgery that, after careful research, feels most comfortable to you.   To preface the history, I must first note that ALL gastric bypass work is based off the Roux-en-Y technique, developed by a French surgeon, Dr. Phillibart Roux, in the 19th century, which involves rerouting the small intestine so that food empties into it instead of the stomach. Note: Though the acronym RNY has been adapted to easily describe the current, commonly performed Roux-en-Y gastric bypass, the technique described by Dr. Phillibart Roux and the current procedure bearing the same name are actually worlds apart.  The history of bariatric surgery begins in the 1950’s when two surgeons from the University of Minnesota , Dr. Kremen and Dr. Linner performed a procedure known as the jejuno-ileal bypass (JIB). This was the FIRST weight loss surgery. It is no longer performed due to severe complications that required the majority of patients to have revisions. The SECOND weight loss surgery the Old Loop Bypass (OLB), was performed by Dr. Edward Mason in 1966. He was the first to create a smaller gastric pouch and could be considered the predecessor to the RNYs performed today. This approach was very successful however the “loop” was created in such a way that bile from the liver flowed across this connection to the gastric pouch and one of it’s major criticisms was that it caused bile reflux into the stomach pouch and esophagus. For this reason, his surgery is no longer performed; however, it provided the building blocks for today's 'pouch' type weight loss surgeries. Variations of this surgery are generically classified as "Open Roux-en-Y" or "Roux Loop", however, the "Y" component was not established until much later. The THIRD (though more accurately this surgery type was released and practiced concurrently during the time period that the Old Loop was i.e. 1966) was the biliopancreatic diversion (BPD), performed by Scopinaro. This surgery was the predecessor to the duodenal switch that is performed today. It differed from the jejunoileal (JIB) bypass by not having a portion of bowel that was a “dead end” like the JIB did. This procedure had significantly fewer problems with liver failure, involved a limited gastrectomy that reduced the amount of food a patient could eat, and a bypass of much of the small bowel which resulted in a significant malabsorptive component (food couldn’t be processed by the intestine). The difficulties with this technique were that patients had significant problems with loose stools, protein malnutrition, excessive and smelly flatus (gas), strong body odor and ulcers at the site where the bowel was connected to another portion of bowel. These 'early DS' complications are what opponents to the DS in its current form like to cite as 'DS Complications'. Due to those problems it is no longer performed. In 1977, Dr. Ward Griffin of the University of Kentucky , combined Dr. Edward Mason's gastric bypass with Dr. Phillibart Roux's Roux-en-Y technique to produce the FOURTH type, the Open Roux-en-Y Gastric Bypass, which was the first RNY as we know it today. Using Roux's technique, Griffin successfully prevented the bile reflux that plagued Mason's original Old Loop procedure.  The FIFTH is the hybrid biliopancreatic diversion duodenal switch first performed by Dr. Doug Hess of Bowling Green, Ohio in 1986. This is the surgery commonly referred to as the DS and is still practiced today. Compared to the BPD, the DS leaves a much smaller stomach. Instead of cutting the stomach horizontally and removing the lower half (such as with the BPD), the DS cuts the stomach vertically and leaves a tube of stomach that empties into a very short (2-4 cm) segment of duodenum. Around this time (the mid 1980s), many versions of the SIXTH type of surgery, the vertical banded gastroplasty (commonly referred to as "Stomach Stapling") came into fashion. This type was not 'pioneered' by any one individual and there were a number of variants of this surgery. Although this was a relatively uncomplicated surgery technically it has become associated with a significant incidence of weight gain a few years after the surgery since the pouch can stretch back to a significant size and there is no malabsorption aspect to this surgery. The Laparoscopic Roux-en-Y gastric bypass (RNY), in it's current form was first performed in 1990. This is the SEVENTH type of weight loss surgery. Though not truly a 'new' type of surgery, as the procedure is performed identically to Ward's 1977 Open RNY, the surgery gained "widespread acceptance" as laparoscopic, minimally invasive procedures began replacing many routinely open procedures. This is the RNY as it is known today. It is not called (generally) the "Laparoscopic Roux-en-Y gastric bypass" as the acronym RNY is now commonly used in reference to all Roux-en-Y gastric bypass procedures. It is also commonly accepted that the RNY in it's current form will be performed laparoscopically whenever possible, thus the term 'laparoscopic' is usually omitted. Between 1990 and present, there have been two common variations of the RNY: the distal and proximal. The distal RNY is accomplished by shortening the common channel to between 100 and 400 cm in length providing a greater malabsorbtive component. The proximal RNY is any RNY with a common channel length greater than 400 cm. The EIGHT type of weight loss surgery is "Gastric Banding" though this concept had been around for decades and had been practiced in Europe and Scandinavia using arterial grafts as the band, the practice only become popular with the development of the inflatable band which was developed by Dr Kuzmak in 1990. Since that time, Gastric Banding has evolved into Laparoscopic Gastric Banding or "Lap Band" a term that is used to describe the banding surgery but is; however, actually referencing the banding product. The LapBand manufactured by Bioenterics, Carpenteria, California which is the sole producer of the only banding product available in the USA at this time, having completed U.S. trials and been approved for use by the FDA. It is now produced by a company named Inamed. A NINTH type of weight loss surgery, a variant of the RNY, known as the Mini Gastric Bypass, was developed by Dr. Robert Rutledge in 1997. This bypass creates a small gastric pouch much lower in the abdomen than previous techniques of this kind and incorporates a “loop” anastamosis (connection) with the small bowel that provides for a malabsorption effect similar to that, which is used in the Roux-en-y bypass. In recent years, a TENTH type of weight loss surgery, the Vertical Sleeve Gastrectomy, has gained popularity. The VSG is actually a variant of the BPD-DS in which the malabsorbtive component is removed from the procedure. Approximately 70% of the stomach is removed leaving a sleeve that greatly restricts the amount of food that can be consumed. As the greater curvature, the part of the stomach removed during this procedure, contains the highest concentration of hunger receptors, the recipients gain a bonus effect of reduced hunger sensations. This procedure is becoming very popular with 'lightweights', people with relatively low BMIs that fall into the obese range. As it has only been practiced regularly within the later part of the last decade, long term weight loss success rates are unknown for this surgery. I have listed a number of surgeries and they all share a common theme, they gave hope to people who had given up on the prospect of a normal life. They allow us to live again (or in some cases for the first time in our lives). All surgery procedures evolve from prior surgeries so to classify even the early surgeries that are no longer performed as failures would not be fair. Those early surgeries were the foundation for the very successful surgeries performed today, and I for one am grateful to all who have worked in this field. Currently the mainstream weight loss surgery options are: RNY, DS, LapBand, and vertical sleeve gastrectomy. Each has a specific type of person it will work best for. Each has inherent risks, and each has its own benefits.  The question is not which surgery is best, but which surgery is best for you. Research all of the types and more importantly talk about your options, both with your surgeons (or prospective surgeons) and with people who have had the surgeries. Try to avoid anyone who is adamantly opposed to any of those surgeries as you may not get the 'whole' truth. My surgeon performs all of the surgeries listed above and we spent nearly four hours determining which one would work best for me. That was four hours of one on one consultation, but it was proceeded by months of research prior to that discussion. Again, and I want to stress this: It is not important which surgery you choose. It is important that you are comfortable with your choice of surgery, surgeon, hospital, and post surgery lifestyle recommendations.