EXPERIENCE WITH JEJUNOILEAL BYPASS FOR OBESITY

  • 1 January 1976
    • journal article
    • research article
    • Vol. 143  (3) , 401-410
Abstract
Patients (58) less than 30 yr old but who weighed more than 300 lb were considered for investigation of jejunoileal bypass. Patients (30) had operations, and the functioning bypass included 40 cm of jejunum and 10 cm of ileum. In 14 patients, intestinal continuity was restored by end-to-end or end-to-side anastomosis according to random choice, and in 16 patients, end-to-end anastomoses were used. The follow-up period is 1-4 yr, and the weight loss, so far, has not been significantly related to the type of reconstruction used. Weight loss correlated positively with the preoperative weights up to 1 yr after operation. Weight loss correlated positively with the total measured length of the small intestine during the 1st 6 postoperative mo., but this correlation currently is showing a trend toward negativity. Food intake decreased by 2682 .+-. 690 cal/day at 6 mo. after operation as a result of the bypass. Chronic acidosis was common. Results of an endocrine evaluation revealed an unexpected significant decrease in parathormone levels within the normal range. A new complication, colonic pseudo-obstruction, occurred 1 yr or more after operation in 5 patients or 17% of the group. This complication is related to the intestinal anaerobic flora in proximity of the defunctionalized limb; its symptoms and signs can be alleviated by giving antibiotics or Lactobacillus to change the intestinal flora. Although 90% of the patients were pleased with their progress, and the results of routine evaluation corroborate their satisfaction, detailed analysis of the research data revealed that only 43% had beneficial effects from a jejunoileal bypass without any of the serious sequelae. Jejunoileal bypass for obesity is justified when carried out by interdisciplinary groups dedicated to the long term follow-up study of the patient and periodic reporting of the results.

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