MEANING OF HISTORY OF BARIATIC SURGERY

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The first bariatric procedure was done in 1954 by Kremen, Linner, and Nelson.8 They performed a jejunoileal bypass to exclude a large segment of small bowel. This decreases the capability to absorb a lot of the nutrients consumed. Bypasses of this nature grew out of favor because patients complained of uncontrollable diarrhea and experienced dehydration and electrolyte imbalances. Jejunoileal bypass was revised in 1996 to a biliopancreatic diversion by Scopinaro et al.9 Biliopancreatic diversion produces its weight-loss effect mainly by malabsorption, but it addittionally includes a small restrictive aspect. The intestinal reconfiguration promotes malabsorption of fat and protein. Patients often lost and maintained a significant quantity of weight but suffered from ulcers, foul-smelling flatus and stool, protein malnutrition, and iron-deficiency anemia. Protein malnutrition is the most serious potential complication of biliopancreatic diversion and might be associated with hypoalbuminemia, anemia, edema, asthenia, and alopecia. Treatment often requires hospitalization with hyperalimentation. The duodenal switch, first presented by Hess and Hess10 in 1998, is really a modification of the biliopancreatic diversion that reduces the severity of protein calorie malnutrition, decreases the incidence of dumping syndrome, and prevents ulcers. Gastric bypass is just about the gold standard of weight-loss surgery. Mason and Ito11 in 1967 developed the principles of gastric bypass surgery when they pointed out that women who’d undergone partial gastrectomy for peptic ulcer disease often were underweight and had difficulty gaining weight. Vertical-banded gastroplasty first reported in 1982 by Mason12 grew in popularity with the advent of mechanical staplers. It had been thought to be a safer alternative to gastric bypass. It was the first purely restrictive operation performed for treating obesity. A sack is done on the lesser curvature of the stomach, and a polypropylene mesh band is positioned around the pouch outlet. You will find hardly any complications attributed to the procedure because no anastomosis is created. Hess and Hess13 later described the initial laparoscopic vertical-banded gastroplasty. Vertical-banded gastroplasty went out of favor because patients are not able to maintain weight loss.

Another purely restrictive bariatric procedure is nonadjustable gastric banding. This procedure was initially described in 1978 by Wilkinson and Peloso,14 who placed a 2-cm Marlex mesh around the top of the main stomach, separating the stomach into a small upper pouch and the remainder of the stomach. This procedure failed secondary to pouch dilation, causing poor weight loss. It had been revised in 1986 by Kuzmak,15 who used a 1-cm Silicone band to encircle the stomach. This created a 13-mm stoma and a 30- to 50-mL proximal gastric pouch. The band was then modified by inserting an inflatable balloon to regulate the band and stoma size.

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