Weight Loss Surgery Trends and Technologies

Weight loss surgery in America has a 60 year history. It begins just after World War II, when the first dedicated weight loss surgery - a now-obsolete procedure called a jejunoileal bypass - was performed in 1954 at the University of Minnesota by Dr. A.J. Kremen.

Over the following decade, physicians began to notice that patients undergoing partial stomach removal for ulcers also experienced quick weight loss. This realization led to the first modern gastric bypass operation (the Ito-Mason gastric bypass), which was performed in 1967. In this "classic" gastric bypass operation, the stomach is separated into a small upper pouch and a larger, lower "remnant". Both are then connected to the small intestine. The functional volume of the stomach is significantly reduced by this process, which alters the patient's physiological and psychological response to food.

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Gastroplasty, or "stomach stapling", was implemented in the early 1970s after the introduction of mechanical tissue staplers. In this procedure, the stomach is stapled to form two portions, with a tiny opening for food to pass between the two. This type of gastroplasty was abandoned due to its ineffectiveness over the long term. Vertical banded gastroplasty (VBG), a related procedure employing a mesh band or silicone ring instead of stapled tissue, is now the accepted standard gastroplasty. However, due to the severe heartburn and relatively rapid weight regain associated with this procedure, it is rarely performed today.

With the dawn of the 1980s came the rise of weight loss surgery technology over technique. The first gastric band was developed by the late Dr. Lubomyr Kuzmak in 1983. The original Dacron band (with a buckle!) was soon replaced by a silicon rubber band lined with an inflatable balloon in 1986. This balloon-like band is placed around the top of the patient's stomach, then tightened by the injection of a saline solution into the band's balloon-like inner layer. This creates a small stomach pouch that restricts food intake, and thus causes weight loss.

Although performed in Europe since its invention, adjustable gastric banding was not practiced in the United States until the Food and Drug Administration (FDA) approved the use of the Lap-Band® and the RealizeTM band in 2001 and 2007, respectively. The big advantage to this type of surgery is its lowered impact on the patient's body.

According to Dr. David Provost, a surgeon with 20 years' experience in weight loss surgery in Denton, Texas, "By using the gastric band, patients have a lower risk of infection and post-operative complications than they do with other weight loss surgery procedures. Gastric banding can also be performed laparoscopically through several small incisions in the abdominal wall rather than through one large, open incision. This greatly lessens the pain associated with recovery, as well as the chances of infection, scarring, or other complications." Dr. Provost's expertise has led him to become a leader in laparoscopic gastric banding surgery, and he has taught hundreds of other doctors how to perform this and other weight loss surgery procedures.

Prior to FDA approval of the gastric band in the U.S., the 1990s saw the rise of a new kind of bariatric surgery: the Roux-en-Y gastric bypass. This procedure has become the most commonly performed operation for weight loss in the United States. It works by cutting away the majority of the stomach and leaving only a small stomach pouch, then bypassing the upper part of the patient's small intestines (reducing the patient's absorption of fatty foods). This operation regarded by surgeons as the most effective weight reduction surgery over the long term.
Another more recent surgical weight-loss procedure is the sleeve gastrectomy, or gastric sleeve. During a sleeve gastrectomy, the stomach is reduced to a narrow channel about 15% of its original size. The open edges of this channel are then attached to form a banana-shaped tube, or sleeve. This permanently reduces the size of the stomach - the procedure is not reversible - but makes overeating essentially impossible.

Doctors and researchers are always investigating new weight loss surgery techniques. Among the most exciting of these are the so-called single-incision procedures, intended to reduce scarring and shorten healing time, and even no-incision gastric sleeve surgery, in which the patient's esophagus is employed instead of an incision to access the stomach.

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