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The Evolution of Bariatric Surgery
Simple Gastric Stapling has been abandoned generally due to the failure of the operation to maintain adequate weight loss, and particularly, due to the high incidence of failure because of the breakdown of staple lines. Horizontal Gastroplasty has failed for many of the same reasons as simple gastric stapling and has likewise been abandoned. Pancreatobiliary Diversion is an operation used in Europe but infrequently In the United States. The NIH Consensus Report indicates there is a high frequency of metabolic complications. Vertical Banded Gastroplasty is one of the two major types of operations recognized by the NIH for the treatment of clinically severe obesity. It is a purely restrictive procedure with no malabsorptive effect. This operation is commonly performed in this country and is a suitable surgical procedure with a very acceptable rate of complications and operative risk. The goal of this procedure is to severely restrict the patient's capacity to eat certain foods. The downside is that it attains a somewhat unpredictable level of weight loss. In addition, it may require difficult modifications. For these reasons Missouri Bariatric Services chooses not to perform this procedure. Roux-en-Y Divided Gastric Bypass (RYDGB) is recognized by the NIH Consensus Report for its effective treatment of clinically severe obesity. This is the procedure favored by our program due to the low complication rate and long term, proven results in achieving weight loss. This procedure combines a gastric restrictive operation with slow gastric emptying. It provides a lifelong tool for the patient for dealing with clinically severe obesity. It has the highest long term success with low rates of mortality, complications and failures. University of Missouri Health Care is convinced the Roux-en-Y Divided Gastric Bypass is currently the "gold standard" in the surgical treatment of clinically severe obesity. This procedure provides an effective loss of 50 to 80 percent of excess weight. In most cases, this is enough weight loss to reduce the life threatening dangers which come with co-morbid conditions. |
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Intestinal Bypass also known as the jejunal-ileal bypass, was the most common bypass operation of the 1970's. This procedure has since been abandoned because of the severe malabsorption effects on the liver and other-organs. Most earlier jejunal-ileal bypasses have been reversed by surgical procedures and upgraded to the gastric restrictive operations.
