It is interesting to observe the repetition of learning that continues in the use of stomach operations. Operations to reduce acid have been replaced by treatment of infection with Helicobacter pylori. Stomach operations for obesity were originally modifications of operations designed for the treatment of acid peptic disease. Now, operations for obesity performed on the stomach must be designed to avoid the production of acid peptic disease. Gastric surgery for ulcer has been lost, but the lessons learned remain of great value.
History does repeat.
In the meantime, severe obesity continues to be morbid and lethal and operations remain the only effective means of treatment. Even a small increase in risk of ulcer is to be avoided because of the long life that most of these patients have. We are now seeing occasional duodenal bleeding and stomal ulcers in patients who had a gastric bypass many years ago. Severe bleeding leads to operations that in turn become complicated, or the bleeding may even be lethal before a diagnosis and appropriate treatment can be applied. Surgeons today must avoid the production of peptic ulcer when they are treating obesity.