Metabolic surgery and its offshoot bariatric surgery have been under development for decades with many rapid advances in recent years. The earliest operations performed for the express intent of weight loss were performed in the 1950s at the University of Minnesota. Dr. Richard Varco completed the first jejunoileal bypass in 1953, a procedure that involved bypassing the majority of the small bowel while leaving the stomach intact [1]. Patients enjoyed a high level of success in weight loss but were fraught with complications including severe vitamin deficiencies, gas-bloat syndrome, kidney stones, liver degeneration, and even mental status changes. The excluded portion of the intestine often suffered complications due to bacterial overgrowth, and a large majority of these patients have had their operations revised [2].

Dr. Edward Mason was trained at the University of Minnesota during the advent of metabolic surgery and later taught surgery at the University of Iowa. There, in 1966, he developed the first gastric bypass procedure consisting of a horizontal gastric division accompanied by a gastrojejunostomy. Inspiration arose from the weight loss observed in patients following gastric resections for peptic ulcers. The procedure was very successful and replaced the jejunoileal bypass in short order. In 1977 back at the University of Minnesota, Drs. John Alden and Ward Griffen advanced the gastric bypass to include gastric cross stapling and a Roux-en-Y reconstruction to publish what we now know as the classic Roux-en-Y gastric bypass. The first laparoscopic Roux-en-Y was performed in 1994 by Dr. Alan Wittgrove [1].

Various iterations of gastric banding, a purely restrictive procedure, have been used throughout the history of bariatric surgery beginning in the late 1970s. The vertical banded gastroplasty was originally devised as a safer alternative to the Roux-en-Y gastric bypass. A number of materials have been used to segregate portions of the stomach including Marlex mesh, Dacron and PTFE vascular grafts, and ultimately silicone in most modern adjustable bands. The adjustable gastric band is still in use and prevalent in modern bariatric surgery [1].