Jejunoileostomy for Extreme Obesity

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Abstract
Jejunoileostomy, with 25 in. of bowel remaining in continuity, and with the ileocecal valve not bypassed, was an acceptable procedure in this patient, allowing weight loss with moderate caloric restriction and weight stability with a liberal diet without disabling diarrhea. Fecal loss of Ca, Mg, and K was not excessive. Compositional studies show that adipose tissue takes place only with concurrent K loss in a setting of extracellular fluid expansion. Energy expenditure, estimated by indirect calori-metry was significantly increased over that predicted from exchangeable K; after further loss of weight, this returned toward normal. Small bowel bypass may be useful as an adjunctive therapy in obesity, rather than as a primary treatment.