Foundations of Bariatric Surgery

As with other surgical specialties, the field of metabolic and bariatric surgery has a rich history and has undergone considerable evolution and expansion since its origins in the 1950s. While initial operations, such as the jejunoileal bypass (JIB), faced considerable challenges secondary to severe complications, breakthroughs by pioneers—such as Mason and Ito in the 1960s—paved the way for the evolution of the Roux-en-Y gastric bypass (RYGB) which remains one of the dominant procedures today. As the role of bariatric operations in treating type 2 diabetes and other metabolic pathologies became increasingly apparent, the concept of metabolic surgery gained traction. And, with the spread of laparoscopy in the 1990s, advancements in minimally invasive techniques were applied to metabolic and bariatric surgery continuing to reduce both the morbidity and mortality of these operations. Later, organizations such as the American Society for Metabolic and Bariatric Surgery (ASMBS) and the American College of Surgeons (ACS) established accreditation and quality standards—further improving the safety of the field. Metabolic operations are now as safe as many low-risk procedures such as cholecystectomy, appendectomy, and hysterectomy. Continued advancements in our understanding of the underlying mechanisms of both metabolic surgery and, in general, obesity have contributed to the recent recognition of obesity as a chronic disease. The future of metabolic and bariatric surgery is promising, and ongoing research into less invasive techniques with a continued evolution of a broader understanding of metabolic health will continue to advance the field.