The Effect of Jejunoileal Bypass on Bile Composition and the Formation of Biliary Calculi

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Abstract
Of 101 patients with small bowel bypass for morbid obesity, 9 developed biliary calculi postoperatively during a mean follow-up period of 29.6 mo. The development of gallstones depends in part on biliary cholesterol saturation and on the zeta potential of bile. In 8 consecutive patients, the lithogenicity of bile was assessed, and postoperatively, the lithogenic score decreased in 6 and increased in 2 patients, 1 of which developed gallstones. Taurine bile salt conjugation tends to prevent aggregation of micelles by increasing the zeta potential. The biliary glycine/taurine ratio increased (P < 0.05) from 4.6 to 5.9 postoperatively. The increased incidence of cholelithiasis following small bowel bypass is not only due to a relative change in bile composition but is probably due to an increase in the biliary glycine/taurine ratio and a consequent decrease in the biliary zeta potential.