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History of Obesity Surgery |
The first operations done for obesity were developed in the 1950s. Initially, the operations were designed to produce malabsorption of food – in other words, calories would pass through the intestinal tract without being picked up and put into the blood stream.
The primary operation of this class was the Intestinal Bypass surgery. Intestinal Bypass rerouted food so that is skipped the majority of the small intestine. The small intestine is where most absorption of nutrients occurs. Because the food was not absorbed most of the calories the patient ate did not make it into the blood stream. Fewer calories meant excellent weight loss, and the Intestinal Bypass was a very effective operation for weight loss.
Unfortunately, other more important things were also not picked up after an Intestinal Bypass surgery. Vitamin and mineral deficiencies were common. Kidney stones formed frequently due to the imbalance of calcium oxalate in the blood. Finally, there was a disruption of the reprocessing of Bile Salts in the intestine. Bile Salts are vital to the smooth functioning of the liver. The liver in turn is responsible for producing a number of vital substances, including proteins for blood clotting, handling of cholesterol and disposal of certain waste products such as blood pigments. A normal working liver is necessary for normal health. Because of the high metabolic cost of Intestinal Bypass this operation was abandoned about 40 years ago, and many of the patients who had the surgery had it reversed with another operation.
The next generation of surgeries depended more on Restriction of the amount of food the person could eat, and less on malabsorption of nutrients. Two main types of operations were common: stomach banding or stapling operations, and the Gastric Bypass surgery. Both were performed as open operations, and, initially, more stomach banding surgeries were done. This was most likely because a stomach banding surgery was easier for the surgeon to perform. However, several well designed studies done in the 1980s showed that the Gastric Bypass surgery was superior to simple stomach banding surgeries (roughly twice as effective). Because of superior weight loss the Gastric Bypass operation became the Gold Standard Surgery for weight loss in the United States, and has remained so until today.
Currently, another operation has become as common as the Gastric Bypass surgery – the Laparoscopic Adjustable Banding or LapBand surgery is the second main operation done for Morbid Obesity in the United States. The LapBand was allowed for use in the US in 2002 by the FDA, but prior to this it had been employed in Europe and Australia for approximately 10-15 years.
Finally, a new operation has recently been proposed as an alternative to both Gastric Bypass and LapBand. The Gastric Sleeve Operation was discussed at a Consensus Conference in New York in October 2007. Although the US data is limited, there is a growing experience in some centers here, as well as in Europe, demonstrating very effective weight loss with fewer long-term problems compared to the more established operations. The weight loss appears to be better than the LapBand in the first few years. Doctor Marvin has recently trained in this technique and has added Gastric Sleeve to his repertoire.
Today there are no well designed clinical studies comparing the Gastric Bypass to the LapBand. The Gastric Sleeve is a new procedure which shows much promise in the early experience. There are both pros and cons for each operation. As a result, Doctor Marvin is trained in all of the common procedures and has had an extensive successful experience with both the Gastric Bypass and LapBand. Under most circumstances Doctor Marvin will allow the patient to decide which operation suits his or her individual preferences.
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