Brief History and Summary of Bariatric Surgery

Chapter 7.

ON THE HORIZON

Many other procedures are in development. The implantable gastric stimulation device uses small electrodes attached to the stomach which, when stimulated electrically, are supposed to create the feeling of fullness. The intragastric balloon is being reintroduced as a simple procedure that can be placed through an endoscope. The balloon is designed to “take up space” and thereby decrease the amount of food patients can eat. Both of these procedures, while interesting in their simplicity, have not had documented adequate long-term weight loss. However, as these procedures are potentially much safer than other operations, they may have a significant role in the future.

STAGED PROCEDURES

Surgeons are also devising different procedures to decrease the complication rate in high-risk patients – patients who have extreme obesity or severe medical co-morbidities. Some surgeons are using a staged approach to bariatric surgery. This approach involves performing a less invasive procedure that reduces weight to a safer level (which in itself is not effective enough on its own) and improves overall medical condition first; then a more complex, definitive procedure is performed once the operative risks of the patient decrease significantly due to the initial weight loss. These less invasive steps have included the “sleeve gastrectomy,” the gastric balloon and the adjustable band as an interim step before a RYGBP or DS is performed.

SUMMARY

Almost all bariatric procedures have resulted in consistent short-term weight loss. Unfortunately there is no perfect operation. The remarkable drive for the obese patient to regain weight cannot be eliminated in all patients. Furthermore, the history of bariatric surgery is replete with procedures that seemed initially to be very promising and safe in theory, but which were later found to be failures. As such, newer procedures should always be viewed with caution. The RYGBP, LAGB, DS and BPD have withstood appropriate scrutiny through the literature. Only through careful research and discussion with a qualified bariatric surgeon can patients decide which procedure may be the best for them.

REFERENCES

Implantable gastric stimulation

Shikora, SA. Implantable gastric stimulation for the treatment of severe obesity. Obes Surg. 2004;14:545-8.

De Luca M, Segato G , Busetto L, et al. Progress in implantable gastric stimulation: summary of results of the European multi-center study. Obes Surg. 2004;14 Suppl 1:S33-9.

Staged procedures

Regan JP, Inabnet WB, Gagner M, et al. Early Experience with Two-Stage Laparoscopic Roux-en-Y Gastric Bypass as an Alternative in the Super-Super Obese Patient Obes Surg 2003;13:861-864.

Nguyen NT , Longoria M, Gelfand DV, et al. Staged laparoscopic Roux-en-Y: a novel two-stage bariatric operation as an alternative in the super-obese with massively enlarged liver. Obes Surg. 2005;15:1077-81.

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TABLE OF CONTENTS

• Chapter 1. INTRODUCTION

• Chapter 2. JEJUNOILEAL BYPASS

• Chapter 3. GASTRIC BYPASS & LAPAROSCOPIC GASTRIC BYPASS

• Chapter 4. BILIOPANCREATIC DIVERSION DUODENAL SWITCH

• Chapter 5. GASTROPLASTY

• Chapter 6. GASTRIC BANDING & LAPAROSCOPIC ADJUSTABLE GASTRIC BANDING

• Chapter 7. ON THE HORIZON & SUMMARY

• References

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