The history of metabolic surgery for morbid obesity and a commentary

Henry Buchwald, Richard D. Rucker

Research output: Contribution to journalArticlepeer-review

23 Scopus citations


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.

Original languageEnglish (US)
Pages (from-to)781-787
Number of pages7
JournalWorld Journal of Surgery
Issue number6
StatePublished - Nov 1981


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