Obesity surgery, as practiced today, has a long history with various attempts made in the past, and modern obesity surgery has been built upon these trials.
An Overview of the Development of Obesity Surgery
The exact timeline of when obesity surgery was first performed and how the early attempts fared is not well-documented. There are references to surgical methods for weight loss even in ancient Greece and ancient Egypt. Therefore, it wouldn’t be inaccurate to say that these methods have a history spanning thousands of years.
Ancient times mark the earliest references to efforts in combatting obesity. Ancient Greek and Egyptian sources suggest recommendations for diet and exercise in obesity treatment. Alexandrian physician Celsus even recommended surgical procedures during this period.
Celsus suggested surgical measures like removing excess skin and reducing the size of an enlarged stomach. However, it is not clear whether these recommendations were actually put into practice, as surgeries during that time were highly risky and often fatal.
Medieval and Renaissance Periods
In the medieval era, limited references to obesity surgery recommendations can be found, but there are no records of actual surgical procedures. Diet and exercise continued to be the primary methods for combating excess weight during this period.
The 20th Century
From the 20th century onwards, with advancements in medicine, bolder ideas related to obesity surgery began to emerge. The foundations for modern treatment methods were laid through experiments conducted on animals during the latter half of this century.
The Birth of Modern Obesity Surgery
The birth of modern obesity surgery can be traced back to the 1950s. It was Swedish surgeon Victor Henriksen who performed the first obesity surgery on a human. Henriksen surgically reduced the small intestines of a morbidly obese patient. He removed about 105 cm of the small intestine.
In the aftermath of the procedure, the patient started losing weight, and the procedure was deemed successful. However, six months later, weight loss stopped, and the patient began gaining weight again. The small intestines had managed to adapt to the reduced absorption within a short period (healthy individuals typically have around 7 meters of small intestine).
During this time, a second attempt was made by Dr. Kremen, who had previously conducted a series of experiments on animals. In 1954, he applied the method he developed on humans. The procedure, known as jejunoileal bypass, directly connected the first and last parts of the small intestine, bypassing approximately 90% of the small intestine.
The procedure resulted in successful weight loss in patients, but when severe issues with vitamin and mineral absorption became apparent, it was entirely abandoned in the 1970s.
In 1967, Dr. Mason performed the first gastric bypass surgery, a procedure that is still performed today. With this surgery, not only was the stomach reduced in size but only a portion of the small intestine was bypassed, ensuring that vitamin and mineral absorption deficiencies were kept at tolerable levels.
By 1976, Dr. Scopinaro from Italy developed the bilio-pancreatic diversion procedure, which involved bypassing even more of the small intestine compared to the gastric bypass. Over time, this procedure evolved into the Duodenal Switch surgery still used today.
The Idea of Stomach Reduction
In the 1980s, the idea of reducing the stomach size to avoid absorption issues gained traction. Initially, the gastric banding method was developed, and in the 2000s, sleeve gastrectomies were introduced.
Stomach reduction gained prominence due to its ability to avoid absorption problems and reduce eating capacity. All these developments led to the emergence of modern obesity surgery.
Modern Obesity Surgery
Modern obesity surgery has evolved after a long process. However, research and development in this field continue, with efforts to create more effective and lower-risk methods. The primary principles underlying modern obesity surgery include:
Reducing stomach size to lower eating capacity Bypassing a portion of the small intestines to reduce food absorption Simultaneously reducing eating capacity and food absorption
It would not be wrong to say that the surgical methods currently practiced today are primarily based on these principles. In the near future, even more effective and lower-risk methods are expected to be developed.