The very first bariatric procedure was done in 1954 by Kremen, Linner, and Nelson.8 They performed a jejunoileal bypass to exclude a sizable segment of small bowel. This decreases the capability to absorb a majority 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 also carries a small restrictive aspect. The intestinal reconfiguration promotes malabsorption of fat and protein. Patients often lost and maintained an important number of weight but experienced ulcers, foul-smelling flatus and stool, protein malnutrition, and iron-deficiency anemia. Protein malnutrition is the most serious potential complication of biliopancreatic diversion and may be related to hypoalbuminemia, anemia, edema, asthenia, and alopecia. Treatment often requires hospitalization with hyperalimentation. The duodenal switch, first presented by Hess and Hess10 in 1998, is 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 has transformed into the gold standard of weight-loss surgery. Mason and Ito11 in 1967 developed the principles of gastric bypass surgery once they noticed that women who had 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 was considered to be a safer alternative to gastric bypass. It was the very first purely restrictive operation performed for treating obesity. A bag is established on the lesser curvature of the stomach, and a polypropylene mesh band is placed across the pouch outlet. There are hardly any complications attributed to this procedure because no anastomosis is created. Hess and Hess13 later described the first laparoscopic vertical-banded gastroplasty. Vertical-banded gastroplasty moved out of favor because patients are incapable of maintain weight loss.

Another purely restrictive bariatric procedure is nonadjustable gastric banding. This procedure was first described in 1978 by Wilkinson and Peloso,14 who placed a 2-cm Marlex mesh around top of the part of the 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 was 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 adjust the band and stoma size.

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