Weight loss surgery

The laparoscopic sleeve gastrectomy, often called the “sleeve”, has a history that stretches back several decades. It did not begin as a stand-alone operation but as part of a much more complex procedure known as the biliopancreatic diversion with duodenal switch (BPD-DS).

In the late 1980s and early 1990s, Dr. Douglas Hess, in the United States, pioneered this approach. He reshaped the stomach into a narrow tube, or “sleeve”, as the first stage of the operation, before carrying out an intestinal bypass.

In the late 1990s, another key figure, Dr. Michel Gagner, working in Canada and later the United States, performed the first sleeve gastrectomy using a laparoscopic or “keyhole” approach. This was a major step forward. Laparoscopic surgery meant smaller incisions, quicker recovery, and less postoperative pain. It made the idea of performing the sleeve more widely attractive.

Around the same time, surgeons such as Dr. Alan Wittgrove were also advancing laparoscopic bariatric techniques, helping to establish minimally invasive surgery as the new standard.

Although originally designed as the first part of a two-stage operation, many surgeons noticed that patients lost significant amounts of weight after just the sleeve, often so much that the second stage of the duodenal switch was not required.

In the early 2000s, surgeons including Dr. Baltasar in Spain, Dr. Regan in the United States, and Dr. Deitel in Canada began publishing their experiences with the sleeve as a stand-alone procedure. Their reports showed excellent weight loss, major improvements in diabetes, blood pressure, and sleep apnoea, and acceptable complication rates.

As evidence accumulated, more centres adopted the sleeve gastrectomy on its own.

By the 2010s, long-term studies confirmed that the operation was not only effective but also safe and durable. From these pioneering efforts, the sleeve has grown into the most widely performed bariatric procedure in the world, recognised by international surgical societies and offered to patients everywhere as a reliable treatment for severe obesity.

The One Anastomosis Gastric Bypass (OAGB) has an interesting journey. The operation was first described in 1997 by Dr. Robert Rutledge, an American surgeon, who called it the Mini Gastric Bypass. His idea was to create a simpler version of the traditional Roux-en-Y bypass by using just one connection between the stomach and the small intestine instead of two.

Early reports showed that patients lost a lot of weight, and the surgery was quicker to perform.

At first, not all surgeons were convinced. Some were concerned about the possibility of bile reflux, and the operation was not widely adopted. However, interest continued to grow.

In the mid-2000s, Spanish surgeons, led by Dr. Miguel Carbajo, refined the technique further. They standardised the way the stomach pouch was made and how much intestine was bypassed. They also gave the procedure a new name: the One Anastomosis Gastric Bypass (OAGB). This helped distinguish it as a recognised surgical option, not just a “mini” version of another operation.

By the 2010s, research and long-term results began to show that OAGB was not only safe but also highly effective for weight loss and improving obesity-related health conditions such as type 2 diabetes, high blood pressure, and sleep apnoea.

Today, more than 25 years after its introduction, the operation is performed worldwide and is included in international bariatric surgery guidelines.

The Roux-en-Y Gastric Bypass, often simply called the “gastric bypass”, is one of the best-known operations for the treatment of severe obesity. Its story stretches back more than half a century and involves several pioneering surgeons whose contributions helped shape modern bariatric surgery.

The roots of the operation go back to the 1950s and 1960s, when surgeons first experimented with different forms of intestinal bypass to achieve weight loss. While these early procedures did lead to weight reduction, they often caused severe nutritional complications. Surgeons began looking for safer ways to combine restriction of food intake with some degree of malabsorption.

In the late 1960s, Dr. Edward Mason at the University of Iowa performed the first gastric bypass operations. He is widely regarded as the “father of obesity surgery”. Dr. Mason initially worked on gastric partitioning procedures and then described the original gastric bypass, which restricted stomach size and rerouted food into the small intestine. His work laid the foundation for what would become the Roux-en-Y technique.

The operation was further refined through the work of Dr. Richard Varco, another American surgeon who contributed to early concepts of intestinal bypass, and later by Dr. Edward E. Mason together with colleagues who promoted gastric bypass as a safer and more effective alternative to pure intestinal bypass.

By the 1970s and 1980s, surgeons adopted the Roux-en-Y reconstruction (named after the Swiss surgeon César Roux, who had described the “Roux-en-Y” method of joining bowel segments in the late 19th century). This reconstruction provided a reliable way to reroute food from a small gastric pouch into the small intestine, reducing complications such as bile reflux and improving patient tolerance.

The next leap came in the 1990s, when advances in minimally invasive surgery allowed the procedure to be performed laparoscopically. Surgeons such as Dr. Alan Wittgrove in the United States performed some of the first laparoscopic Roux-en-Y gastric bypass operations. This reduced recovery time and made the procedure more accessible and popular.

Over time, the Roux-en-Y Gastric Bypass (RYGB) became one of the most studied and widely performed bariatric procedures in the world. Decades of research have confirmed its effectiveness for long-term weight loss and for improving obesity-related conditions such as type 2 diabetes, high blood pressure, and sleep apnoea.

Today, the Roux-en-Y Gastric Bypass remains a cornerstone of bariatric surgery.

I am an independent surgeon, but I operate out of St George’s Hospital, one of Christchurch’s leading healthcare facilities. Enjoy comfortable surroundings and the support of dedicated nursing staff delivering quality care throughout your stay.

Weight loss surgery typically requires a 2-night stay.

It depends on the type of medication. Here is a pre-op guide to find out more. If you have any doubt or further questions, don't hesitate to reach out to me or your GP.

Visit the FAQs if you have more questions, or get in touch with me for any other concerns.