The Future of Bariatric Surgery

An excerpt from an interview conducted with Dr. Mason, the father of bariatric surgery. The entire interview is published in Surgery of Obesity and Metabolic Disorders (SOARD), volume 11, issue 2, pages 286-287. In this editorial, Dr. Mason endorses gastric fundus invagination as a potential replacement of sleeve gastrectomy. Gastric Fundus Invagination (GFI) also known as Sleeve Gastrotomy is a novel weight loss procedure designed and developed by Dr. Darido. Gastric fundus invagination has many advantages including reversibility, simplicity, and safety.

Interviewer: “What do you envision the future of bariatric surgery will be?”

Dr. Mason: “Sleeve gastrectomy is becoming the current operation of choice. Unfortunately, sleeve gastrectomy is more complex and irreversible. Epidemics of obesity and type-2 diabetes have spread to adolescents and children. Fortunately, Elias [3], and co-workers [2,3] have shown in rodent and growing porcine models that the ballooning portion of the stomach can be invaginated rather than resected [2,3]. The invaginated fundus is anastomosed internally to the antrum, fundic invagination could be called a sleeve gastrotomy, since it is to sleeve gastrectomy as gastric bypass is to gastric resection. My goal for gastric bypass was to “Keep it simple, surgeon” _and be reversible. I envision sleeve gastrotomy as the operation of choice for all ages and times. However, this procedure has not yet been evaluated in humans.”

Dr. Mason continues to say: “Darido’s sleeve gastrotomy (fundic invagination) should be as successful as sleeve gastrectomy. My original goal of decreasing the need for stomach resection will again be fulfilled. Complete stomachs will remain available by a simple reversal operation if needed later in life to provide digestion, dilution and perhaps normal dumping with greater knowledge and the cohesion of paradigms. “Scientific Discipline Will Replace Empiric Craft.” My mentors, Owen and Sara Wangensteen, used this in a subtitle for their history ofsurgeryin1978 [5]. Thank you for the honor of speaking at this meeting and thanks to all of those who made this possible. A special thanks to Elias Darido and coworkers for their imagination of invagination with internal anastomosis of the fundus to the antrum. Save the stomach, using education, scientific study and clinical translation. Keep it simple, surgeon. “

Edward E. Mason, M.D., F.A.C.S.

Emeritus Professor of Surgery, University of Iowa School of Medicine Iowa City, Iowa



[2] Darido E, Overby D W, Brownley K A, Farrell T M. Evaluation of gastric fundus invagination for weight loss in a porcine model. Obes Surg 2012;22(8):1293–7.

[3] Darido E, Moore J R. Comparison of gastric fundus invagination and gastric greater curvature plication for weight loss in a rat model of diet- induced obesity. Obes Surg 2014;24(6):897–902.

[5] Wangensteen O, Wangensteen S. The rise of surgery. From empiric craft to scientific discipline. London: Dawson Company, 1978.

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