Page 13 - IFSO-History-Book-Digital-File

Gastroplasty was introduced by Printen and Mason in 1973 [22]. Their original version consisted of a
partial horizontal gastric transection, leaving a greater curvature conduit. In 1981, Laws and
Piantadosi made the pouch vertical and restricted the outlet with a Silastic ring [23]. One year later,
in 1982, Mason described his vertical banded gastroplasty (VBG) using a Marlex mesh band through
a gastric window to restrict the VBG outlet [24]. The VBG saw a rapid increase in the number of cases
performed, rivalling the RYGB for dominance in the 1980s and 1990s. Unfortunately, over time, VBG
patients began to regain their weight. With the ascendency of the laparoscopic adjustable gastric
band, the VBG procedure became obsolete.
Scopinaro wanted to achieve the weight loss of the JIB without its complications and diarrhea. To
achieve that goal, he postulated that the bypassed bowel cannot remain quasi-stagnant, but must
have a continuous flow of contents to prevent bacterial overgrowth and that the ‘water-wringer’
terminal ileum must be preserved. Therefore, in 1979, he performed a horizontal hemi-gastrectomy
with pouch drainage by a Roux limb of at least 250 cm length, joining a long biliopancreatic limb to
form the common ileal segment of 50 cm [25]. When Scopinaro’s BPD moved across the Atlantic in
1997, it was converted by Picard Marceau et al of Canada to a vertical sleeve gastrectomy with
cross-stapling of the duodenum and an approximately 100-cm common channel [26]. The duodenal
cross-stapling was, however, transitory and soon dehisced, abolishing the operative effect. In 1998,
Douglas S. Hess and Douglas W. Hess of the US conceived the modern biliopancreatic duodenal
switch (BPD/DS), or duodenal switch (DS), by performing a sleeve gastrectomy with pyloric
preservation, duodenal division, a proximal duodenal ileostomy, and a common channel of
approximately 100 cm [27].
The BPD and the DS are difficult, time-consuming operations. These procedures can also be
associated with long-term protein and other nutritional deficiencies, with possible liver failure. Thus,
the surgeon committed to these procedures must also be committed to life-long follow-up for these
patients. In the proper hands, BPD/DS offers the most lasting weight loss and resolution of obesity
associated diseases of any MBS operation.

The concept of the laparoscopic adjustable gastric band started with the nonadjustable gastric
band, introduced in 1978-1983, independently by Lawrence H. Wilkinson, Marcel Molina, and
Horacio E. Oria [16]. In 1986, Lubomyr I. Kuzmak patented and reported his own experience with the
adjustable gastric band (AGB) [28]. Laparoscopic AGB soared in usage and was favored by both
surgeons and patients in the 1990s and early 2000s. Then, long-term failure of weight loss and
recurrent weight gain, as well as long-term complications (e.g., band slippage and perforation)
became problematic. The use of laparoscopic AGB subsequently declined rapidly, with most AGB
patients being converted to other MBS operations.
The free-standing sleeve gastrectomy (SG) was first advocated by Regan et al, in 2003, [29] and
subsequently popularized by Michel Gagner [30]. Since this operation requires no bowel
manipulation or anastomosis, the SG became the most frequently performed MBS operation in the
2013-2014 era. However, a disturbingly high incidence of staple line leaks in the fundus of the sleeve
have been reported. This issue has stimulated an entire literature on either leak prevention by
reinforcing buttressing materials or oversewing, as well on how to treat these leaks. A possibly safer
alternative to SG is gastric plication, originally described as an open procedure by Tretbar et al in
1976 [31], modernized into a laparoscopic technique by Talebpour in 2006 [32], paving the way for
Fried and Doležalová’s validation of the procedure's durability with their 10-year outcomes [33].

Various modifications of prior MBS procedures have gained advocacy. Mathias A.L. Fobi, in 1991,
introduced the banded gastric bypass to prevent outlet stretching and recurrent weight gain [34].
Andrés Sánchez-Pernaute, Antonio Torres, and others advocate an SG with a duodenoileostomy, a
single-anastomosis DS (SADI-S) [35]. Several MBS innovations have been and are being assessed,
including pacemaker stimulation of various “normal” organs and various bowel transpositions. An
intriguing MBS addition has been the introduction of minimally invasive laparoendoscopic magnetic

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