Effects of jejunocolic shunt on obesity, serum lipoproteins, lipids, and electrolytes

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Abstract
Serum lipid levels of 11 grotesquely obese patients, studied before and for various periods up to 6 years after jejunocolic anastomosis, showed a decrease within 2 weeks. They decreased further during the period of rapid reduction in weight and stabilized at least 40% below preoperative levels when the body weight was constant. In 2 patients, studied for 5 and for 6 years, whose weight has been near "ideal normal" for at least 4 years, serum cholesterol and[long dash]S 25-40 B -lipoprotein levels have been consistently decreased at least 50%, while a-lipoprotein concentrations are at the preoperative levels. Before operation, 1 patient had hyperglyceridemia and high levels of serum[long dash]S>400 and[long dash]S70-400 B-lipoproteins; for 1 year after the shunt they have been normal. Studies of fat absorption if 4 patients showed the average increase in serum triglyceride concentration after a high-fat meal was lessened from an average of 63% before to 18% after operation, while the decrease in plasma-free fatty acid concentration, which normally occurs after the meal, was unaltered. Three patients who exhibited prolonged bouts of vomiting and anorexia also showed mild tetany and muscle weakness requiring hospitalization for correction of electrolyte deficiency. At these times serum Mg levels were low (0. 8 mg/100 ml), and serum C levels were at the low limits of normal or slightly below normal. In the other 7 patients weekly intramuscular injections of 1 ml of 50% MgSO4 solution prevented development of clinical signs of deficiency. Jejunocolic shunt performed in grossly obese patients is an effective method of reducing weight without regaining it. After a period of adjustment ranging from 2 to 10 months, diarrhea and fluid and electrolyte problems became less troublesome. The fact that 2 patients have requested that continuity of the bowel be restored because of chronic fatigue suggests that others will do likewise after variable periods of weight reduction. We believe that currently the procedure is useful only for those whose lives are threatened by the complications of obesity. Patients who have achieved a desirable weight fail to adhere to good eating habits; their problem is not solely related to weight adjustment.