Page 53 - IFSO-History-Book-Digital-File

CHAPTER FOUR

The Laparoscopic Revolution in
Metabolic Bariatric Surgery

Luigi Angrisani, Francesco Angrisani, Francesco Saverio Papadia,
Nicola Di Lorenzo, Maurizio De Luca

Laparoscopic techniques are now the standard of care for metabolic bariatric surgery (MBS)
procedures worldwide. This brief account traces the early stages of this remarkable transformation,
in which Professor Luigi Angrisani was a participant at the end of the last century.
In 1995, a meeting between Angrisani and Professor Nicola Scopinaro initiated a professional
relationship that quickly evolved into a close friendship. The occasion was the first hands-on MBS
TM
course on the Lap-Band , sponsored by the Inamed company, held in Todi, a small medieval town
in Umbria, central Italy. At that time, Scopinaro was already a giant in the field, internationally
renowned, and Angrisani, a young and enthusiastic “laparoscopic surgeon” eager to learn more
about obesity.

Dr. Alan Wittgrove had already demonstrated the feasibility of laparoscopic Roux-en-Y gastric
bypass (RYGB), the Lap-Band was beginning its rise to prominence, and laparoscopic vertical
banded gastroplasty (VBG) was being performed in only a few centers. MBS, itself, was still a niche
field, and most surgeons considered obesity a relative contraindication for laparoscopic
approaches. In January 1996, Angrisani initiated a laparoscopic surgery obesity program at the
Department of Surgery of Federico II University in Naples, performing adjustable gastric banding
(AGB). Over the following three years, he chaired a national meeting that gathered the Italian
experience in this field, with the active participation of Scopinaro and many leading Italian surgeons.
The Lap-Band device had been approved for marketing in Europe and worldwide, but not in the
United States (US). Suboptimal results of trials conducted in the US were not well received by the the
Food and Drug Administration (FDA), which denied approval at that time, preventing its
commercialization there.
Meanwhile, laparoscopic surgery for obesity was expanding rapidly, with exponential growth
resembling “another French Revolution,” as it was referenced colloquially, that followed the prior
introduction of laparoscopic cholecystectomy in Germany and France. It was a period of
unprecedented enthusiasm in general surgery. Strong support also came from international
companies that introduced new devices, systems, and technologies; they promoted courses,
meetings, and congresses globally to foster continuous education and updates in the evolving field.
As laparoscopy spread across all disciplines of abdominal surgery, more than 90% of MBS
procedures performed globally were AGB operations, which were broadly indicated for nearly all
patients with obesity.

Despite his deep respect for Nicola as a man, scientist, and surgeon, Angrisani was convinced that
laparoscopic techniques would eventually replace open surgery for all MBS procedures. Scopinaro

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