Evolution of operative procedures for the management of morbid obesity 1950-2000

Henry Buchwald, Jane N. Buchwald

Research output: Contribution to journalArticlepeer-review

211 Scopus citations


Background: At the turn of the 21st century, obesity is the epidemic with the greatest prevalence in the United States. Fifteen million people, 1 out of 20, in this country have a body mass index (BMI) ≥35 kgm2. Obesity is not only a medical problem, but also a social, psychological, and economic problem. At present, the morbidly obese are refractory to diet and drug therapy, but have a substantial, sustained weight loss after bariatric surgery. Methods: This chronology of the landmark operations in bariatric surgery is based on a review of the medical literature. Results: Bariatric surgery can be classified into 4 categories: malabsorptive procedures, malabsorptive/restrictive procedures, restrictive procedures, and other, experimental procedures. The prototype of malabsorptive procedures and the first operation performed specifically to induce weight loss was the jejunoileal bypass. The problems associated with this operation caused its demise. Today's popular malabsorptive procedures are the biliopancreatic diversion and the duodenal switch. Malabsorptive/restrictive surgery currently is predicated on the Roux-en-Y gastric bypass, both the traditional short-limb, and the long-limb for the super obese. Restrictive procedures are represented by the banded and ringed vertical gastroplasty, as well as gastric banding. Experimental procedures include gastric pacing. All of these operations can be performed by open surgery and laparoscopically. Conclusions: Since bariatric surgery is the only broadly successful treatment for morbid obesity, it is incumbent on all physicians to be familiar with current bariatric operations, and to understand the evolution of bariatric surgery.

Original languageEnglish (US)
Pages (from-to)705-717
Number of pages13
JournalObesity Surgery
Issue number5
StatePublished - Oct 2002

Bibliographical note

Funding Information:
Presented in part at the 5th Congress of the International Federation fothe rSurg ery of Obesit,Gy naeItaol,,yS etempber 22, 2000 and at the 18th Annual Meeting of the American Society foBarriatric Surgery, Wahingston, D,J Cnu8,e20 10. This work wsupaporsted by anun strirctedeeucadtional grant from Ethicon Endo-Surgery,I n., Cinccinnati, OH. Reprint requests to: D. Henrry Buchwald, University of Minnesota, 420 Delaware St. SE, Mayo Mail Code 290, Minneapolis, MN 55455 USA. Fax: 612-625-3206; e-mail: [email protected]


  • Bariatric surgery
  • Malabsorptive
  • Morbid obesity
  • Restrictive


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