What are basic concepts of bariatric surgery?

Updated: May 28, 2019
  • Author: Alan A Saber, MD, MS, FACS, FASMBS; Chief Editor: John Geibel, MD, MSc, DSc, AGAF  more...
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Answer

In 1954, Kremen and Linner introduced jejunoileal bypass, the first effective surgery for obesity in the United States. In this procedure, the proximal jejunum was connected directly to the distal ileum, bypassing 90% of the small intestine out of the intestinal stream of ingested nutrients (blind loop). The procedure induced a state of malabsorption, which led to significant weight loss.

However, many patients developed complications secondary to malabsorption (eg, steatorrhea, diarrhea, vitamin deficiencies, oxalosis) or due to the toxic overgrowth of bacteria in the bypassed intestine (eg, liver failure, severe arthritis, skin problems). Consequently, many patients have required reversal of the procedure, and the procedure has been abandoned. This led to a search for better operations.

Modifications in the original procedures and the development of new techniques led to the following three basic concepts for bariatric surgery (see Surgical Therapy):

  • Gastric restriction (adjustable gastric banding, sleeve gastrectomy)
  • Gastric restriction with mild malabsorption (Roux-en-Y gastric bypass)
  • Combination of mild gastric restriction and malabsorption (duodenal switch)

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