ABSTRACT
Metabolic surgery is defined as the operative manipulation of a putatively normal organ or organ system to achieve a biological result for a potential health gain. Bilateral oophorectomy suggested in 1889 for metastatic breast cancer was probably the first metabolic surgery procedure; gastric/vagal surgery for duodenal ulcers and partial ileal bypass for hyperlipidemia were the most common prior to bariatric surgery. There have been well over 50 weight-losing operations advocated for, starting with the jejunoileal bypass (1953), followed by gastric bypass (1966), vertical banded gastroplasty (1971), biliopancreatic diversion (1979), adjustable gastric banding (1986), duodenal switch (1994), and sleeve gastrectomy (2004). The mitigating effects of bariatric surgery on a myriad of metabolic diseases, such as type 2 diabetes, cardiovascular manifestations, and even cancer caused bariatric surgery to be considered metabolic surgery; the elucidation of multiple neurohormonal mechanisms elicited by metabolic/bariatric surgery confirmed this conclusion, as well as firmly establishing obesity as a metabolic disease entity. Today's adventures in metabolic surgery include brain and vagal stimulation for obesity and depression, carotid sinus stimulation for hypertension, perirenal sympathetic vascular ablation and partial ileal bypass for type 2 diabetes, and metabolic/bariatric surgery for traumatic brain injury.
