The most effective known treatment for obesity is surgery. These treatments involve surgical intervention in organs or tissues that function normally in order to achieve better health. It is desired that the side effects of these surgeries are minimal. The existence of side effects from the surgeries, the potential for new diseases to arise in the patient, the inability to achieve sufficient weight loss, or the regaining of weight has led surgeons to develop different surgical options. Obesity surgeries have undergone significant changes from their inception to the present day. Many surgeries that were performed in the past are no longer in use today. This can be seen as a prediction that different types of surgeries may be developed in the future or that we may refrain from performing certain surgeries.

All obesity surgeries have effects on conditions such as hypertension, type 2 diabetes, and hyperlipidemia, in addition to their weight-loss effects. Therefore, all obesity surgeries are also considered metabolic surgeries. The terms obesity surgery and metabolic surgery complement each other and should not be viewed separately. The term bariatric surgery can also be used for all these operations.

With the recognition of obesity as a disease, the first bariatric surgeries began to be performed in the 1950s. Initially, surgeries were performed where no intervention was made to the stomach, and a large portion of the small intestine was bypassed, directly connecting the first part of the small intestine to the large intestine. Jejunoileal bypass and jejunocolic bypass are examples of these surgeries. Patients lost weight effectively in the early stages and achieved lasting weight control. However, in the long term, serious vitamin and mineral deficiencies, diarrhea, gas bloating, kidney stones, fatty liver disease and cirrhosis, skin rashes, and neurological problems were observed. These surgeries were gradually abandoned over time.

Starting in the 1960s, gastric bypass surgeries were performed based on the principle of creating a new pathway between the stomach and intestines by removing a portion of the stomach or reducing its volume. Many bypass procedures have been defined. These surgeries have both volume-reducing effects on the stomach and malabsorption effects. Since the 2000s, bariatric surgeries have become possible to perform laparoscopically. Today, various types of gastric bypass surgeries are performed depending on the surgeon’s preference. Roux-en-Y gastric bypass (RYGB), mini gastric bypass (MGB), biliopancreatic diversion (BPD), duodenal switch (DS), transit bipartition (TB), and SADI-S are examples of these surgeries. They each have various advantages and disadvantages over one another; however, there is still no definitive answer to the question of which surgery is the best in the literature. Currently, RYGB and MGB are the two most commonly performed bariatric bypass surgeries.

Restrictive surgeries were designed to reduce stomach volume, allowing patients to experience early satiety and reduce the intake of large amounts of food. In the 1970s, vertical and horizontal gastroplasty surgeries, which involved only intervention to the stomach, were described, in contrast to gastric bypass surgeries. Although they were quite popular at first, they were abandoned quickly due to a high rate of weight regain.

With the end of gastroplasty surgeries, adjustable gastric banding began to gain prominence in the 1990s and early 2000s. It was applied as a popular method for many years. Due to complications associated with the gastric band (band slippage, band migration, stomach perforation, port-related complications), it has been abandoned. Although it is still performed in some centers today, it is not preferred in routine bariatric surgical practice.

Sleeve gastrectomy, performed as part of the DS surgery, was designed as a staged surgery for super obese patients. It was observed that in most cases, it provided sufficient weight loss on its own without the need for a second surgery, and it was defined as a standalone surgery in 2005. This surgery, which reduces the stomach to a thin, long tube, quickly became popular. Since 2014, it has become the most commonly performed bariatric surgery worldwide.

Looking at the evolution of bariatric surgeries, there is a trend toward simpler and easier-to-apply techniques rather than complex ones, from multiple anastomoses to single anastoses, and from surgeries with many side effects to those with fewer and more reliable side effects. Considering these characteristics, RYGB, MGB, and sleeve gastrectomy surgeries are currently at the forefront.

1. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery: a systematic review and meta-analysis. JAMA. 2004;292:1724–37.
2. Buchwald H. The evolution of metabolic/bariatric surgery. Obes Surg. 2014 Aug;24(8):1126-35. doi: 10.1007/s11695-014-1354-3. PMID: 25008469.
3. Rutledge R, Kular K, Manchanda N. The Mini-Gastric Bypass original technique. Int J Surg. 2019 Jan;61:38-41. doi: 10.1016/j.ijsu.2018.10.042. Epub 2018 Nov 24. PMID: 30476553.
4. Moshiri M, Osman S, Robinson TJ, Khandelwal S, Bhargava P, Rohrmann CA. Evolution of bariatric surgery: a historical perspective. AJR Am J Roentgenol. 2013 Jul;201(1). doi: 10.2214/AJR.12.10131. PMID: 23789695.