Stomach Stapling and the Father of Gastric Bypass Surgery

Most people when they hear that somebody they know has had weight loss surgery think in terms of ‘stomach stapling’ and are generally unaware of the fact that there are several different forms of weight reduction surgery available nowadays.

Stomach stapling was however the very first form of what we now call ‘gastric bypass surgery’ and the very first operation was more properly called the ‘Horizontal Gastroplasty’.

During the 1960s Dr Edward E Mason of the University of Iowa was treating women suffering from peptic ulcer disease by carrying out a partial gastrectomy and noticed that his patients lost weight following surgery and that the weight generally stayed off. As a result, he then applied the principles of the partial gastrectomy in treating obese women by partitioning off the upper section of the stomach using staples and, in so doing, became the father of obesity surgery.

During the Second World War the Russians developed a number of surgical instruments which could be used quickly and efficiently to deal with war wounds by stapling various different body tissues together. These instruments were then further developed after the war by a number of American instrument manufacturers and gave rise to several instruments still in use today which are capable of creating up to four parallel rows of staples to partition the stomach. In addition, refinements to these instruments to include a knife also allowed the newly partitioned tissue to be cut and separated as well as stapled in a single operation. Instruments were also developed to create circular rows of staples so that the ends of two tubes, such as those found in the intestine, could be joined together.

In early stomach stapling operations a horizontal row of staples was inserted to partition off the top section of the stomach and then three staples were removed from the center of the stapling line to create a small opening, or stoma, through which food could pass. The small top portion of the stomach would lead the patient to feel full after eating only a very small quantity of food, which would then work its way slowly through the stoma into the main section of the stomach below and be digested in the normal manner.

Unfortunately, this particular early form of obesity surgery had one major drawback and that was that the muscle of the stomach wall stretched over time so that the stoma became enlarged and food began to pass quite quickly into the main stomach sack. This meant that patients tended to lose weight nicely for several months but that their weight then tended to stabilize and start to rise again, often right back to the level at which they started. As if this were not enough, the staple line in these early surgeries often became disrupted and this caused a variety of often serious medical complications.

Today of course gastric bypass, or obesity, surgery has been refined considerably and medical and technological advances have cured many of the problems of early procedures.