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excess weight on average, and, crucially, weight loss was maintained for decades. In the first
long-term follow up of 40 patients observed for more than ten years, average recurrent weight gain
was <1% of the weight lost [2].

Managing the Price of Efficacy

Scopinaro was honest about the trade-off. To guarantee excellent weight loss in nearly all patients,
he deliberately designed the BPD to be “a little too effective” for a minority. About 7% of patients
experienced a single episode of protein malnutrition within the first year, requiring short-term
intravenous supplementation. In 3% of patients, the malabsorption was excessive and permanent,
requiring a simple revisional operation to lengthen the common channel, after which, nutrition
normalized without recurrent weight gain. As Scopinaro wrote in the 1980s, “The final result is a lean
and healthy person in one hundred percent of cases.” The only routine supplements needed were
calcium to prevent bone demineralization and iron for menstruating women. No other operation for
obesity had ever produced such consistent, long-term results with manageable side effects.

Uniting the World: The Founding of IFSO (1995)

By the early 1990s, bariatric surgery was still a fragmented field. Dietitians, endocrinologists,
psychiatrists, and surgeons often worked in isolation, and some openly questioned whether surgery
had any role in treating obesity. Scopinaro believed that obesity was a multifactorial disease,
biological, psychological, and social, and that no single discipline could solve it alone. In 1995, in
Stockholm, he convened a small group of international leaders and founded IFSO. He became its
first president. The goal was not just to create a surgical society, but to build a global,
interdisciplinary community that included physicians, nutritionists, psychologists, and basic
scientists. IFSO grew rapidly, and Scopinaro’s vision of collaborative, evidence-based MBS became
the global standard of care. He later founded the IFSO European Chapter and remained Honorary
President of both organizations until his death.

Embracing Laparoscopy: The Naples Symposium (1999)

Scopinaro was a master of open surgery, and initially he was skeptical about the ability of
laparoscopy to perform complex gastrointestinal operations. But he was also a true scientist: open
to evidence and ready to change his mind. And, as those who knew him well understood, he loved
competition. He was a champion parachutist, a pilot, a man who thrived on challenges. He did not
fear being surpassed; he welcomed it, because it meant the field was advancing.
Luigi Angrisani recalls meeting Nicola Scopinaro in 1995 in Todi, a small medieval town in Umbria,
during a hands-on course on the laparoscopic gastric band. Many young Italian laparoscopic
surgeons were there, eager to learn. He was there as a witness of the national and international
surgical academy. Listening to his presentations, the young surgeons were extremely impressed by
his rigorous modern scientific method. Although he was somewhat skeptical about laparoscopy for
complex operations, he accepted Luigi Angrisani’s proposal to organize the First International
Symposium on Laparoscopic Obesity Surgery under IFSO’s auspices. It was held in Naples in March
1999, and was the beginning of a new era.
The meeting was attended by surgeons from 27 countries. It brought together the “old guard” of
open MBS, Edward Mason, Lloyd MacLean, and others, with the “young foxes” of laparoscopy. In
May 2000, the IFSO World Congress in Genoa was another triumph, with Scopinaro’s “My Way”
lecture as its moral centerpiece.

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