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Long-Term Consequences After Jejunoileal Bypass for Morbid Obesity

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Abstract

This study assesses the long-term results ofjejunoileal bypass (JIB) in 43 prospectively followedpatients whose surgical bypass remained intact.Follow-up was 12.6 ± 0.25 years from JIB. Weightloss and improved lipid levels, glucose tolerance,cardiac function, and pulmonary function weremaintained. Adverse effects such as hypokalemia,cholelithiasis, and B12 or folate deficiency decreasedover time. The incidence of diarrhea remained constant(63% vs 64% at five years), while the occurrence ofhypomagnesemia increased (67% vs 43% at five years, P< 0.05). Nephrolithiasis occurred in 33% of patients. Hepatic fibrosis developed in 38% of patientsand was progressive. Overall, after more than 10 years,35% of patients appeared to benefit from JIB as definedby alleviation of preoperative symptoms and the development of only mild complications (vs47% at five years). On the other hand, irreversiblecomplications appeared to outweigh any benefit derivedfrom the JIB in 19% (vs no patients at five years; P < 0.01). In summary, patients with JIBremain at risk for complications, particularly hepaticfibrosis, even into the late postoperativeperiod.

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REFERENCES

  1. Hocking MP, Duerson MC, O'Leary JP, Woodward ER: Jejunoileal bypass for morbid obesity: Late follow up in 100 cases. N Engl J Med 308:995-999, 1983

    PubMed  Google Scholar 

  2. Knodell RG, Ishak KG, Black WC, Chen TS, Craig R, Kaplowitz N, Kiernan: Formulation and application of a numerical scoring system for assessing histological activity in asymptomatic chronic active hepatitis. Hepatology 1:431-435, 1981

    PubMed  Google Scholar 

  3. New weight standards for men and women. Stat Bull Metrop Insur Co 40:1-4, 1959

  4. Kirkpatrick JR: Jejunoileal bypass: A legacy of late complications. Arch Surg 122:610-614, 1987

    PubMed  Google Scholar 

  5. Anderson PE, Pilkington TR, Gazet JC: Reversal of jejunoileal bypass in patients with morbid obesity. Br J Surg 81:1015-1017, 1994

    PubMed  Google Scholar 

  6. Baddely RM: An epilogue to jejunoileal bypass. World J Surg 9:842-849, 1985

    PubMed  Google Scholar 

  7. Goral R, Tuszeski M: Long-term results of jejunoileostomy for extreme obesity. Acta Chir Scand 151:151-158, 1985

    PubMed  Google Scholar 

  8. Mustajoki P, Lempinen M, Huikiri K, Pelkonen R, Nikkila E: Long-term outcome after jejunoileal bypass for morbid obesity. Int J Obes 8:319-325, 1984

    PubMed  Google Scholar 

  9. Rasmussen I, Enblad P, Arosenius KE: Jejunoileal bypass for morbid obesity. Report of a series with long-term results. Acta Chir Scand 155:401-407, 1989

    PubMed  Google Scholar 

  10. Requarth JA, Burchard KW, Colacchio TA, Stukel TA, Mott LA, Greenberg ER, Weismann RE: Long-term morbidity following je junoileal bypass: The continuing potential need for surgical reversal. Arch Surg 130:318-325, 1995

    PubMed  Google Scholar 

  11. Jorgensen S, Olesen M, Gudman-Hoyer E: A review of 20 years of jejunoileal bypass. Scand J Gastroenterol 32:334-339, 1997

    PubMed  Google Scholar 

  12. Sax HC: Current summaries. JPEN 19:328-329, 1995

    Google Scholar 

  13. Kral JG: Surgical treatment of obesity. Med Clin North Am 73:251-264, 1989

    PubMed  Google Scholar 

  14. Goldberg RB, Weinberg RB, Landau RL: Changes in plasma apolipoprote ins A-I, A-II, and B, and lipoprotein cholesterol after jejunoileal bypass. Gastroente rology 84:732-736, 1983

    Google Scholar 

  15. Kral JG, Bondjers G: Increase d arte rial-tissue cholesterol after intestinal bypass in severe obesity. Lancet 2:288-289, 1978

    Article  PubMed  Google Scholar 

  16. Rucker RD Jr, Chan EK, Horstmann J, Chute EP, Varco RL, Buchwald H: Searching for the best weight reduction operation. Surgery 96:624-631, 1984

    PubMed  Google Scholar 

  17. Charles P, Mose kilde L, Sondergard K, Jensen FT: Treatment with high-dose oral vitamin D2 in patients with jejunoileal bypass for morbid obesity: Effect on calcium and magnesium metabolism, vitamin D me tabolites, and faecal lag time. Scand J Gastroenterol 19:1031-1038, 1984

    PubMed  Google Scholar 

  18. Swenson SA Jr, Lewis JW, Sebby KR: Magnesium metabolism in man with special reference to jejunoileal bypass for obesity. Am J Surg 127:250-255, 1974

    Article  PubMed  Google Scholar 

  19. Sellin JH, Meredit SC, Kelly S, Schneir H, Rosenberg IH: Prospective evaluation of metabolic bone disease after jejunoileal bypass. Gastroenterology 87:123-129, 1984

    PubMed  Google Scholar 

  20. Halverson JD, Haddad JG, Bergfeld M, Teitelbaum SL: Spontaneous healing of jejunoileal bypass-induced osteomalacia. Int J Obes 13:497-504, 1989

    PubMed  Google Scholar 

  21. Sorensen HA, Frandsen NJ, Hyldstrup L: Late calcium metabolic consequences of jejuno-ileal bypass. Obes Surg 2:219- 223, 1992

    Article  PubMed  Google Scholar 

  22. Reisenauesr AM, Halsted CH, Jacobs LR, Wolfe BM: Human intestinal folate conjugase: Adaptation after jejunoileal bypass. Am J Clin Nutr 42:660-665, 1985

    PubMed  Google Scholar 

  23. Ayub A, Faloon WW: Gallstones, obesity, and jejunoileostomy. Surg Clin North Am 59:1095-1101, 1979

    PubMed  Google Scholar 

  24. O'Leary JP, Thomas PW, Woodward ER: Urinary tract stone after small bowel bypass for morbid obesity. Am J Surg 127:142-147, 1973

    Article  Google Scholar 

  25. Schaffner F, Thaler H: Nonalcoholic fatty liver disease. Prog Liver Dis 8:283-298, 1986

    PubMed  Google Scholar 

  26. Powell EE, Cooksley WGE, Hanson R, Searle J, Halliday JW, Powell LW: The natural history of nonalcoholic steatohepatitis: A follow-up study of forty-two patients for up to 21 years. Hepatology 11:74-80, 1990

    PubMed  Google Scholar 

  27. Styblo T, Martin S, Kaminski DL: The effects of reversal of jejunoileal bypass operations on hepatic triglyce ride content and hepatic morphology. Surgery 96:632-640, 1984

    PubMed  Google Scholar 

  28. Vyberg M, Raon V, Andersen B: Pattern of progression in liver injury following jejunoileal bypass for morbid obesity. Liver 7:271-276, 1987

    PubMed  Google Scholar 

  29. Hamilton DL, Vest TK, Brown BS, Shah AN, Menguy RB, Chey WY: Liver injury with alcoholic-like hyalin after gastroplasty for morbid obesity. Gastroenterology 85:722-726, 1983

    PubMed  Google Scholar 

  30. Ranlov I, Hardt F: Regression of liver steatosis following gastroplasty or gastric bypass for morbid obesity. Digestion 47:208-214, 1990

    PubMed  Google Scholar 

  31. Silverman EM, Sapala JA, Appelman HD: Regression of hepatic steatosis in morbidly obese persons after gastric bypass. Am J Clin Pathol 104:23-31, 1995

    PubMed  Google Scholar 

  32. Drenick EJ, Fisler J, Johnson D: Hepatic steatosis after intestinal bypass-prevention and reversal by metronidazole irrespective of protein-calorie malnutrition. Gastroenterology 82:535-548, 1982

    PubMed  Google Scholar 

  33. Lichtman SN, Sartor RB, Keku J, Schwab JH: Hepatic inflammation in rats with experimental small intestinal bacterial overgrowth. Gastroenterology 98:414-423, 1990

    PubMed  Google Scholar 

  34. Wanless IR, Lentz JS: Fatty liver hepatitis (steatohaptitis) and obesity: An autopsy study with analysis of risk factors. Hepatology 12:1106-1110, 1990

    PubMed  Google Scholar 

  35. Kral JG: Therapy of severe obesity. InBockus Gastroente rology, 5th ed. Haubrich, Schaffner and Berk (eds.). Philadelphia, WB Saunders Co., 1994

    Google Scholar 

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Authors
  1. Michael P. Hocking
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  2. Gary L. Davis
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  3. Daisy A. Franzini
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  4. Edward R. Woodward
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Hocking, M.P., Davis, G.L., Franzini, D.A. et al. Long-Term Consequences After Jejunoileal Bypass for Morbid Obesity. Dig Dis Sci 43, 2493–2499 (1998). https://doi.org/10.1023/A:1026698602714

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