THE STORY OF WEIGHT LOSS SURGERY
Gastric Bypass History and Development
Weight loss surgery was introduced in the United States in the 1960's. The gastric bypass was based on the weight loss observed among patients undergoing partial stomach removal for ulcers. Over several decades, the gastric bypass has been modified into its current form, using a Roux-en-Y limb of intestine (RYGBP). Because the bypassed portion of intestine is where the majority of calcium and iron absorption takes place, anemia and osteoporosis are the most common long-term complications of the RYGBP, lifelong mineral supplementation is mandatory.
Other clinically important deficiencies that may occur include: Vitamin B 1 (thiamine) and Vitamin B 12 deficiencies. Lifelong follow-up with a bariatric program and daily multi-vitamins are strongly recommended to prevent nutritional complications. Although we are seeing a rapid increase in people electing to have lap band surgery, gastric bypass surgery remains the most common form of weight loss surgery performed in the United States today.
Development of the Lap Band®
The LAP-BAND® System was approved by the FDA in June 2001 for use in weight reduction for severely obese adults with a Body Mass Index (BMI) of 40 or more, or for adults with a BMI of at least 35 plus at least one severe obesity related health condition, such as Type 2 diabetes, hypertension and asthma.The name "lapband®" originated from the surgical technique used, laparoscopic, and the name of the implanted medical device, gastric band.
The LAP-BAND® System is a silicone ring designed to be placed around the top portion of the patient's stomach, creating a small gastric pouch and stoma. The inner surface of the band is inflated with sterile saline to create the proper stoma diameter and pouch size. By reducing stomach capacity, the lapband® may help achieve long-term weight loss in overweight and severely obese adults by creating an earlier feeling of satiety thus limiting or reducing food consumption. The LAP-BAND® System is adjustable, which means that the inflatable band can be tightened or loosened to help the patient achieve a level of satiety while maintaining a healthy diet.*
Sleeve Gastrectomy Development
The history of the sleeve gastrectomy is more an evolution of prior procedures than a discrete timeline of development of a single procedure. The sleeve gastrectomy has evolved from an open duodenal switch procedure to an open sleeve gastrectomy to a laparoscopic sleeve gastrectomy. The earliest experience was in 2001 to 2003 in higher risk patients with super-morbid obesity as a safer staged procedure but this quickly developed into a single-stage option for lower BMI patients. The reason this procedure is safer in higher BMI patients is because the lack of an intestinal bypass reduces complication risk associated with gastric bypass surgery.
This procedure generates weight loss solely through gastric restriction (reduced stomach volume). The stomach is restricted by stapling and dividing it vertically and removing more than 85% of it. This part of the procedure is not reversible. The stomach that remains is shaped like a very slim banana and measures from 1-5 ounces (30-150cc),. The nerves to the stomach and the outlet valve (pylorus) remain intact with the idea of preserving the functions of the stomach while drastically reducing the volume. By comparison, in a Roux-en-Y gastric bypass, the stomach is divided, not removed, and the pylorus is excluded. The Roux-en-Y gastric bypass stomach can be reconnected (reversed) if necessary. Note that there is no intestinal bypass with this procedure, only stomach reduction. The lack of an intestinal bypass avoids potentially costly, long term complications such as marginal ulcers, vitamin deficiencies and intestinal obstructions.
Laparoscopic Greater Curvature Plication
Laparoscopic Greater Curvature Plication (LGCP) is currently an investigational procedure that is being performed on a select basis. Similar to laparoscopic sleeve gastrectomy, the LGCP is a restrictive procedure limiting the volume of food your stomach can hold. However, unlike the sleeve, your stomach will not be cut; it will instead be sewn into a small tube shape. The word "plication" means to fold in. This procedure involves folding the greater curve of the stomach in upon itself two times thereby occupying the majority of the volume of the stomach with the stomach itself, in essence creating a sleeve of stomach through which food will pass. Northwest Weight Loss Surgery received approval for this clinical trial in August of 2011.
||Professor Dag Hallberg, in cooperation with a Swedish medical equipment company, developed the first concept for the gastric band. His work was followed by Dr.Lubomir Kuzmak, who pioneered the technology in the United States.
June marked the first use of open adjustable silicone gastric banding (ASGB).
In April, ASGB was used for the first time in Europe. In December, the first FDA approved ASGB clinical trial started in the United States and the first ASGB workshop was held in Europe.
|The first laparoscopic banding procedure was performed.
||U.S. based medical device company, Inamed Corporation, created the first workshop for the LAP-BAND System in Europe.
||The FDA approved the Investigational Device Exemption (IDE) for a clinical study of the LAP-BAND System in the United States.
||Sleeve Gastrectomy used as a staging operation prior to gastric bypass in high BMI patients.
||The LAP-BAND® System received FDA approval for commercial distribution.
||Sleeve Gastrectomy more available to lower BMI patients as a standalone procedure.
||Northwest Weight Loss Surgery performs first Laparoscopic Greater Curvature Plication surgery in Washington State.
||To date, Northwest Weight Loss Surgery has performed over 4550 weight loss surgeries.
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Chapman A, Game P, O'Brien P, Maddern G, Kiroff G, Foster B, Ham J. Executive summary: Laparoscopic adjustable gastric banding for the treatment of obesity: Update and re-appraisal. Australian Safety and Efficacy Register of New Interventional Procedures-Surgical (ASERNIP-S) ReportNo. 31, Second Edition. Adelaide, South Australia: ASERNIP-S, June 2002. (Laparoscopic adjustable gastric banding surgery, like the LAP-BAND surgery, is associated with a mean short-term mortality rate of around 0.05% compared to 0.50% for Gastric Bypass and 0.31% for Vertical BandedGastroplasty.)ii Parikh MS, Shen R, Weiner M, Siegel N, Ren CJ. Laparoscopic bariatric surgery in super-obese patients (BMI>50) is safe and effective: a review of332 patients. Obes Surg. 2005 Jun-Jul;15(6):858-63.iii Chapman AE, Kiroff G, Game P, Foster B, O'Brien P, Ham J, Maddern GJ. Laparoscopic adjustable gastric banding in the treatment of obesity: asystematic literature review. Surgery 2004;135:326-351.iv O'Brien P, Dixon J, LAP-BAND: Outcomes and Results, J of Laparoend & Adv Surg Techniques, 13(4), 2003, 265-270.