| The
concept of gastrointestinal surgery to control obesity grew out of results
of surgeries for cancer or severe ulcer disease in which large portions
of the stomach or small intestine were removed. After the surgery, doctors
noticed that in many cases patients were unable to maintain their pre-surgical
weight. With further study, surgeons were able to recommend similar modifications
that could be safely used to produce weight loss in morbidly obese patients.
The
first operation that was widely used for severe obesity was the intestinal
bypass. This operation, first used 40 years ago, produced weight loss by
causing malabsorption. The idea was that patients could eat large amounts
of food, which would be poorly digested or passed along too fast for the
body to absorb many calories. The problem with this surgery was that it
caused a loss of essential nutrients and its side effects were unpredictable
and sometimes fatal. The original form of the intestinal bypass surgery
is no longer used.
The
first ileojejunal bypass (a malabsorptive procedure) was performed in 1959
by Dr. John Linear. Stapling was introduced in 1977 by Dr. John Alden.
In 1991 there where two procedures endorsed by the medical community, the
Vertical Bended Gastroplasty (VBG) and the Roux-en-Y Gastric Bypass (RGB).
The
National Institutes of Health has held three Consensus Conferences on morbid
obesity:
-
1978.
Morbid obesity was classified as a life-threatening, life-shortening, life-crippling
disease. Criteria was set at 100 pounds over Ideal Calculated Weight as
defined by the Metropolitan Height and Weight Tables or 75 to 80 pounds
over IDC with two associated life-threatening conditions.
-
1985.
Criteria for morbid obesity was further defined by using Body Mass Index,
which is calculated by dividing weight in kilograms by height in meters
squared. A BMI of 40, or 35 to 40 with two associated life-threatening
conditions, is the criteria for morbid obesity.
-
1991.
Two procedures were "endorsed" for the treatment of morbid obesity: vertical
banded gastroplasty (VBG) and the Roux-en-Y gastric bypass (RGB).
Over the
last decade, bariatric surgery procedures have been continually refined
in order to improve results and minimize risks. Today’s bariatric surgeons
have access to a substantial body of clinical data to help them determine
which surgeries should be used and why.
Morbid
obesity is a complex, multifactorial chronic disease. Weight-loss surgery,
when compared to other interventions, has provided the longest period of
sustained weight loss in patients for whom all other therapies have failed.
In 1992, an NIH study revealed that any medically supervised program or
combination of therapies for weight loss failed 96 to 98 percent of the
time over a five-year period. For many patients, the risk of death from
not having the surgery is greater than the risk for the possible complications
of having the procedure. |
