TY - JOUR
T1 - The history of metabolic surgery for morbid obesity and a commentary
AU - Buchwald, Henry
AU - Rucker, Richard D.
PY - 1981/11
Y1 - 1981/11
N2 - This paper serves as an introduction to a symposium on "Surgical Treatment of Morbid Obesity." It offers a brief historical review of the antecedents for and the operative interventions in this field of metabolic surgery. In essence, the procedures can be divided between jejunoileal operations and their derivatives, and gastric operations. The jejunoileal bypasses originated with end-to-end jejunoileostomy; deviated to end-to-side jejunocolic, jejunocecal, and finally jejunoileal bypasses; and returned to end-to-end jejunoileal bypasses with different lengths of functioning bowel and various sites for colonic drainage of the bypassed bowel. More recently, pancreatic-biliary-intestinal bypass operations have been proposed. The gastric operations can be separated into gastric bypasses with closure of the fundic pouch and anastomosis to a segment of small intestine; gastroplasty with separation of the stomach into a small upper pouch communicating via a limiting orifice to the remainder of the stomach; and gastric partitioning, the simplest variation of gastroplasty, consisting of a cross-stapling of the stomach with omission of several central staples. Finally, vagotomy alone has been advocated. We must conclude with the commentary that there is no optimal operation in this field, but that we need not apologize for an "85% cure rate." What we must work toward in the future is the development of therapy based not on circumvention but on an understanding of the satiety factor.
AB - This paper serves as an introduction to a symposium on "Surgical Treatment of Morbid Obesity." It offers a brief historical review of the antecedents for and the operative interventions in this field of metabolic surgery. In essence, the procedures can be divided between jejunoileal operations and their derivatives, and gastric operations. The jejunoileal bypasses originated with end-to-end jejunoileostomy; deviated to end-to-side jejunocolic, jejunocecal, and finally jejunoileal bypasses; and returned to end-to-end jejunoileal bypasses with different lengths of functioning bowel and various sites for colonic drainage of the bypassed bowel. More recently, pancreatic-biliary-intestinal bypass operations have been proposed. The gastric operations can be separated into gastric bypasses with closure of the fundic pouch and anastomosis to a segment of small intestine; gastroplasty with separation of the stomach into a small upper pouch communicating via a limiting orifice to the remainder of the stomach; and gastric partitioning, the simplest variation of gastroplasty, consisting of a cross-stapling of the stomach with omission of several central staples. Finally, vagotomy alone has been advocated. We must conclude with the commentary that there is no optimal operation in this field, but that we need not apologize for an "85% cure rate." What we must work toward in the future is the development of therapy based not on circumvention but on an understanding of the satiety factor.
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U2 - 10.1007/BF01657963
DO - 10.1007/BF01657963
M3 - Article
C2 - 7043911
AN - SCOPUS:0019770462
SN - 0364-2313
VL - 5
SP - 781
EP - 787
JO - World Journal of Surgery
JF - World Journal of Surgery
IS - 6
ER -