Bariatric surgery passed its Golden Anniversary in 2004. During the past five decades, numerous procedures, beginning with jejunoileal bypass, have come and gone. The concept of “stomach stapling,” which produces substantial restriction of food intake, evolved considerably over time.
In the 1970’s, measurements of the pouch volume capacity and stoma size were reduced to dimensions that supposedly allowed patients to eat with an acceptable degree of discomfort and still lose weight. However, keeping the weight off was a problem. Stretching of both the pouch and stoma were cited as the main culprits of weight regain after the early stomach stapling procedures.
The First Stoma Fixes
During that early era, two surgical techniques were introduced to reduce the size of a stretched stoma:
- Banding the stoma with prosthetic material which eventually evolved into the current adjustable gastric band, or LAP-BAND.
- Suturing the stoma circumferentially to make it tighter which evolved into the current StomaphyX.
In the 1980’s and 90’s, the procedures used for stoma size reduction, gastric banding and stomal suturing were performed through large abdominal incisions. Nowadays, both adjustable gastric banding and StomaphyX are performed using minimally invasive techniques. In fact, no incision is required for StomaphyX procedures.
During the past three decades, it was also learned that weight loss failure after a bariatric operation involving the stomach was almost never remedied by merely adding more “restriction” in the form of either banding or suturing the stoma. To date, there have been only isolated success stories of banding a failed gastric bypass. Additionally, there’s been essentially no long term success associated with either suturing or gluing (another reported approach) a stretched stoma.1Conversely, experts have found that surgical approaches adding malabsorption to either a failed banding or gastric bypass offer reasonable hope for satisfactory long term weight loss.