The Bariatric surgical field has experienced extraordinary changes over the past 55 years.
With the initial empiric use of Intestinal Bypass surgery in 1954 by Kremen, Linner and Nelson at the University of Minnesota, severe obesity was identified as a disease that could be successfully treated.
Today, the acceptance of Bariatric Surgery is a proven surgical discipline. It hasn’t always been that way, and has gone through a long bumpy road in a very hostile environment. It has gone from acid critics and nonbelievers to a great demand of this kind of surgery all over the world.
The increase of obesity over the past 50 years has doubled or tripled in some countries.
One third of the population in the United States is obese (23 million) and patients seeking surgical treatment are becoming heavier each year.
The increase in weight has occurred in men, women and children of all ages.
The need of healthcare due to co-morbidities, is also rapidly escalating, which has greatly affected the public healthcare system and in the economy.
Some of the initial procedures have been abandoned because of serious complications. We have learned from these procedures what not to do, what to avoid and how to do it better.
Over the years, we have also learned about many different surgical techniques. We have learned it’s short and long term complications, the procedures that gave poor results and the procedures that have produced good results. We continue to be properly trained for new techniques and new procedures, how to be involved in the designs of instruments and devices and to make the surgery easier. To help improve results of Bariatric Surgery, we learn how to apply new technology to our procedures like using the laparoscopic towers to decrease mortality, pulmonary insufficiency, operative time, hospital stay and pain.
Now we offer several procedures in which obesity would be prevented or cured by surgical means with similar long term results.
After all, we are facing 2 main problems now with so many patients that had a Bariatric Procedure and a lot of others seeking help: What would be the best Surgical Treatment to be offered to the patient? And, how can we give the best Follow-Up care to make them succeed and avoid complications?
At where we stand now, we cannot say that one Bariatric Procedure over the others will always work for everyone. We have to recommend the best procedure for the patient. Sitting down and talking with the patient is imperative to make the right choice for them. We need to see what he understands and knows about different Weight Loss Procedures. We need to get to know his habits and his environment. We need to know what co-morbidities he has, know his fears, and most important, the commitment and the desire of making changes to his life.
Restrictive procedures like the Lap band and the Gastric Sleeve have lower operatory and long term complications. These procedures are also less expensive than the Gastric Bypass and the Duodenal Switch but need a lot more commitment from the patient to follow diet restrictions and exercise to succeed.
It is well know that complex procedures such as Gastric Bypass and Duodenal Switch gives patients the desired weight loss during the first year, but causes unwanted Malabsorption. Even if the procedure has failed and the patient gains the weight back, he will have long term unwanted complications such as metabolic bone diseases which include Osteoporosis (from poor calcium absorption), Osteomalacia (from vitamin D deficiency), Osteopenia and Osteitis Fibrosa Cystica (from Secondary Hyperparathyroidism due to low serum calcium).
These diseases require long term, close follow-up care to prevent complications. Our offices are sometimes not capable of providing follow-up care for different reasons. Many times the patient is unable to remember who performed his surgery or they have relocated.
Surgical goals should offer a lifetime decrease in Medical Healthcare. Not only to offer the treatment for obesity and the actual problems that obesity creates, but to have a Follow-up System established for 15 to 20 years later.