title: The evolution of minimally invasive bariatric surgery.
abstract: BACKGROUND
  Obesity is a pandemic associated with significant morbidity and mortality. This historical article charts the progress of successful strategies that have been used to tackle weight loss from dietary modifications to the development of surgical interventions that have subsequently evolved. It also provides a précis of the reported outcome data following minimally invasive bariatric procedures.
  
  
  METHODS
  A literature review was performed. All articles relevant to the progression of bariatric surgery and minimally invasive surgery were assessed, as were those articles that described the ultimate evolution, combination, and establishment of the two techniques.
  
  
  RESULTS
  This article charts the progression of early weight loss strategies, from early dietary modifications and pharmacologic interventions to initial techniques in small bowel bypass procedures, banding techniques, and sleeve gastrectomies. It also describes the simultaneous developments of endoscopic interventions and laparoscopic procedures.
  
  
  CONCLUSIONS
  A range of procedures are described, which differ in their success in terms of loss of excess weight and in their complication rates. Weight loss is greatest for biliopancreatic diversion followed by gastric bypass and sleeve gastrectomy and least for adjustable gastric banding. Bariatric surgery is an evolving field, which will continue to expand given current epidemiologic trends. Developments in instrumentation and surgical techniques, including single access and natural orifice approaches, may offer further benefit in terms of patient acceptability.
authors.affiliation: Department of General Surgery, Leicester Royal Infirmary, Leicester, UK.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Batchelder
authors.forename: Robert
authors.initials: R
authors.lastname: Williams
authors.forename: Christopher
authors.initials: C
authors.lastname: Sutton
authors.forename: Achal
authors.initials: A
authors.lastname: Khanna
mesh_terms: D050110:Bariatric Surgery / Q000266:history* / Q000379:methods; D049673:History, 20th Century; D049674:History, 21st Century; D006801:Humans; D019060:Minimally Invasive Surgical Procedures / Q000266:history* / Q000379:methods; D009765:Obesity / Q000601:surgery; D016896:Treatment Outcome; D015431:Weight Loss
keywords: Bariatric surgery; Evolution; Minimally invasive