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Editorials |6 September 2011

Primum Non Nocere

Edward H. Livingston, MD

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Author, Article, and Disclosure Information
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1746.
Requests for Single Reprints: Edward H. Livingston, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room E7-126, Dallas, TX 75390-9156; e-mail, edward.livingston@utsouthwestern.edu.
  • From University of Texas Southwestern Medical Center, Dallas, TX 75235.
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Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M11-1746.
Requests for Single Reprints: Edward H. Livingston, MD, University of Texas Southwestern Medical Center, 5323 Harry Hines Boulevard, Room E7-126, Dallas, TX 75390-9156; e-mail, edward.livingston@utsouthwestern.edu.
To do no harm has been a guiding tenet of medicine for millennia. In this context, bariatric surgery warrants serious consideration. Bariatric operations undoubtedly induce weight loss, but at what cost? Consideration of the balance between benefits and harms calls into question the overall utility of bariatric surgery and, most important, what the appropriate end points should be.
Weight loss is a good start. Bariatric procedures were devised to induce weight loss in patients who could not lose weight by modifying diet and exercise alone. The first operation was the ill-fated jejunoileal bypass, a procedure that caused substantial nutrient malabsorption resulting in weight loss. Because jejunoileal bypass was the first successful treatment for morbid obesity, clinicians embraced it until its substantial complication profile became evident (1): Years after surgery, bacterial overgrowth in the bypassed intestinal limb led to accumulated damage to the liver and cirrhosis. Roux-en-Y gastric bypass and biliopancreatic diversion procedures were devised to surgically induce weight loss and avoid the long-term complications associated with jejunoileal bypass.
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Livingston EH. Primum Non Nocere. Ann Intern Med. ;155:329–330. doi: 10.7326/0003-4819-155-5-201109060-00012

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Published: Ann Intern Med. 2011;155(5):329-330.

DOI: 10.7326/0003-4819-155-5-201109060-00012

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