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General Information on Bariatric Surgery and History

Bariatric surgery is the second most commonly performed laparoscopic surgery after cholecystotomy in the United States.

The first bariatric surgery was performed by a Swedish surgeon, Victor Henrikson. Henrikson, MD operated a morbidly obese woman to lose weight and removed 105-cm portion of the small intestine. He did not specify which portion of the small intestine he had removed and why he had preferred 105 cm in his article.

He reported that the patient started to lose weight in the first period, but during the 6-month follow-up, the patient was found to be 2 kg heavier than she had been before the surgery. Removal of a small portion of the small intestine was tolerated by the remaining portions and no malabsorbtion developed.

Later, in 1954, Kremen, MD developed the surgery called Jejunoileal bypass, in which the first 25 cm and the last 10-15 cm of the small intestine are ligated and almost 90-95% of the small intestine is bypassed.

Although this surgery is extremely successful in weight loss, it has been abandoned at the beginning of the 70s due to fatal malabsorbtion of vitamin, mineral and energy it causes. In 1967, Mason, MD developed the gastric bypass surgery.

In this surgery, both the stomach is reduced and it causes a very less and easily tolerated malabsortion than jejunoileal bypass. In 1976, an Italian surgeon, Scopinaro, MD developed biliopancreatic diversion surgery, in which the small intestine is removed much more, leading to more malabsorption than gastric bypass.

Later in recent years, it was converted into the duodenal switch surgery, the popularity of which has gradually increased and in which the natural valve at the stomach output is preserved.

At the beginning of the 1980s, surgeries that could be effective only by reducing the volume of the stomach without impairing the absorption became a current issue and Kuzmak, MD presented gastric band surgery known as stomach stapling.

In the forthcoming years, it was modified to the surgery using adjustable band. In the early 2000s, sleeve gastrectomy surgery was described as the initial surgery for patients with very high rates of body mass index.

Since patients were observed to have lost more weight close to ideal than expected after this procedure, planned as the first intervention before gastric bypass, it has become a more commonly performed procedure nowadays. Sleeve gastrectomy is currently the most commonly performed bariatric intervention in our country.

Surgeries performed for obesity help lose weight in 3 ways.

1) By reducing the amount of food by reducing the stomach volume.

2) By bypassing a portion of the small intestine to prevent food contact.

3) By providing both of these effects in a single procedure.