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messages to the hypothalamus and other cerebral structures) responsible for the outcomes of
bariatric surgery. In essence, bariatric surgery elicited healing bodily responses by putatively normal
organs. Indeed, bariatric surgery is metabolic surgery.
In recognition, in 2007, of these outcomes, the American Society for Bariatric Surgery (ASBS)
changed its name to the American Society for Metabolic and Bariatric Surgery (ASMBS), and the
International Federation for the Surgery of Obesity (IFSO), added to its name, “and Metabolic
Disorders.” In 2025, IFSO again altered its name to “International Federation for the Surgery and
Other Therapies for Obesity,” in recognition of the advent of multimodal obesity and T2D therapy by
metabolic bariatric surgery (MBS) working in concert with pharmaceuticals.

Bariatric Surgery

The Talmud states that Rabbi Eleazor, who suffered from severe obesity, underwent an operation
after being given a soporific potion wherein his abdomen, or abdominal wall, was opened and a
number of “baskets of fat were removed.” Though this procedure may not precisely represent MBS,
and can best be classified as plastic or reconstructive surgery, it may be the first written report of a
surgical operation to induce weight loss.

The jejunoileal bypass (JIB) of Varco, Kremen, Linner, and Nelson [4] was the first surgery procedure
specifically designed to treat obesity and the first to demonstrate the metabolic healing outcomes
the operation elicited. There were several variations of the JIB. The two most prominent were the
14-to-4 inch, end-to-side JIB, first reported by Payne and DeWind in 1969, and the 40-to-4 cm,
end-to-end JIB with an ileocecostomy to drain the bypassed segment [16].

The JIB caused excellent and lasting weight loss, however, burdened by extensive early and late
complications. These included electrolyte imbalances, vitamin and mineral deficiencies, diarrhea,
gas bloat syndrome, oxalate kidney stones, steatohepatitis and progressive liver degeneration,
cutaneous eruptions, and difficulties in mentation. The causative mechanisms postulated for these
problems were the short bowel syndrome and bacterial overgrowth in the bypassed small intestine,
with the elaboration of toxins and alcohol. Most of these problems could be anticipated, prevented,
and treated. Nevertheless, with the advent of safer procedures, the JIB was essentially abandoned.
Over time, most of the JIB patients had their procedure reversed, with or without another MBS
operation being performed concurrently. There are, however, JIB patients alive today who are doing
well, with excellent weight loss and minimal or no problems.

Edward E. Mason, long recognized as the “Father of Bariatric Surgery,” trained at the University of
Minnesota and subsequently made his bariatric surgery contributions at the University of Iowa.
Mason and Ito published their landmark paper on gastric bypass in 1967 [17]. This first gastric
bypass operation consisted of a horizontal gastric division with a loop gastrojejunostomy. In 1977,
the gastric bypass saga returned to Minnesota, where John F. Alden did gastric cross-stapling with a
loop gastrojejunostomy to drain the functioning gastric pouch [18]. Ward O. Griffen and co-workers,
in the same year, once again at the University of Minnesota, reported the first gastric bypass with a
Roux-en-Y gastrojejunostomy, the classic RYGB [19]. Quite independently, Pories and co-workers
developed the same operation at the University of East Carolina (the Greenville Bypass) [20]. In
1994, Alan C. Wittgrove et al first reported performing the RYGB laparoscopically, thereby,
transforming operative MBS [21].

The RYGB rapidly rose in popularity and replaced JIB as the MBS procedure of choice. RYGB, with a
few ups and downs, has retained its prominence worldwide. Satisfaction is generally high among
RYGB patients, though, over time, the failure rate is rising and the request for revisional surgery is
increasing.

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