Metabolic-bariatric surgery: An emerging specialty

Abstract

After the end of the second world war, the world saw a significant period of growth and prosperity unlike any previously. By the 1950s, morbid obesity was proving to be a clinical problem in many developed societies in Europe and North America. Diet, lifestyle and medication alone did not appear to be effective in controlling morbid obesity, and surgical interventions were developed. Surgical therapies to combat the epidemic of obesity evolved from intestinal bypasses (which had the potential for serious fluid, electrolyte and nutritional disturbances) to eventually settle on manipulations that involve restrictive procedures of the stomach with or without bypass of the duodenum and jejunum. This branch of surgery was referred to as "bariatric" (from the Greek "baros" for weight), but recent awareness that concomitant obesity-related metabolic diseases can also be effectively treated by these procedures has given rise to the new specialty of metabolic-bariatric surgery (MBS). This review looks at current MBS procedures and their impact on gastro-intestinal physiology to achieve both weight loss and metabolic control.