Evolution of Obesity Surgeries
The most effective treatment for obesity is surgery. These treatments involve surgical intervention in organs or tissues that function with normal physiology to become healthier. It is desired that the side effects of these surgeries, which are performed to be healthier, are minimal. The fact that the surgeries have side effects, cause diseases that did not exist before, not lose enough weight or result in weight gain again have led surgeons to develop different surgeries. Obesity surgeries have undergone major changes since they were first performed. Many surgeries performed in the past are not performed today. This can be considered a prediction that different types of surgeries may be performed in the future, or that we will not perform some surgeries.
All obesity surgeries have effects on diseases such as hypertension, type 2 diabetes and hyperlipidemia, as well as weight loss effects. For this reason, all obesity surgeries are also metabolic surgeries. Bariatric surgery and metabolic surgery are terms that complement each other and should not be considered separately. The term bariatric surgery can also be used for all these surgeries.
With the acceptance of obesity as a disease, the first bariatric surgeries began to be performed in the 1950s. First of all, surgery was performed in which most of the small intestine was bypassed and the first part of the small intestine was connected directly to the large intestine, without any intervention on the stomach. Jejunoileal bypass and jejunocolic bypass surgeries are examples of these surgeries. The patients lost good weight in the early period and permanent weight control was achieved. However, in the long term, serious vitamin and mineral deficiencies, diarrhea, flatulence, kidney stones, fatty liver and cirrhosis, skin rashes, and neurological problems were observed. These surgeries were abandoned over time.
Since the 1960s, gastric bypass surgeries, which are based on the principle of creating a new path between the stomach and the intestine by removing a part of the stomach or narrowing its volume, have begun to be performed. Many bypass procedures have been described. These operations are operations that both reduce the volume of the stomach and have malabsorption effects. Since the 2000s, bariatric surgeries have become laparoscopic. Today, different types of gastric bypass surgeries are performed depending on the preference of the surgeons. Roux en y gastric bypass (RYGB), mini gastric bypass (MGB), biliopancreatic diversion (BPD), Duodenal switch (DS), Transit bipartition (TB), SADI-S are examples of these surgeries. They have various advantages or disadvantages to each other, but; There is still no answer to the question of the best surgery in the literature. In the current approach, RYGB and MGB are the two most commonly performed bariatric bypass surgeries.
Restrictive surgeries were designed with the aim of reducing the stomach volume and reducing the patient’s early satiety and excessive food intake. In the 1970s, vertical and horizontal gastroplasty surgeries were defined, which included only gastric intervention, unlike gastric bypass surgeries. Although they were very popular when they were first applied, they were soon abandoned as they resulted in a high rate of weight regain.
With the end of gastroplasty surgeries, the application of adjustable gastric bands began to come to the fore in the 1990s and early 2000s. It has been used as a popular method for many years. It was abandoned due to the complications of the gastric band applied (band slippage, band migration, gastric perforation, port complications). Although it is applied in some centers today, it is not preferred in routine bariatric surgery practice.
Applied as part of DS surgery, sleeve gastrectomy was designed as a phased surgery in super obese patients. It was defined as a stand-alone surgery in 2005 when it was seen that it provided sufficient weight loss on its own without the need for a second surgery in most cases. This surgery, in which the stomach is made into a thin, long tube, quickly became popular. Since 2014, it has become the most frequently performed bariatric surgery in the world.
Considering the development of bariatric surgeries; there is a tendency from technically complex to simpler and easier to apply, from multiple anastomosis to single anastomosis, from anastomotic to non-anastomotic, from those with many side effects to those with few and reliable side effects. Considering these features, RYGB, MGB and sleeve gastrectomy surgeries come to the fore today.
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- Moshiri M, Osman S, Robinson TJ, Khandelwal S, Bhargava P, Rohrmann CA. Evoluti