Skip to main content

Advertisement

SpringerLink
Log in

A prospective comparison of the jejunoileal and gastric bypass operations for morbid obesity

  • Original Scientific Reports
  • Published:
World Journal of Surgery Aims and scope Submit manuscript

Abstract

A prospective, randomized clinical trial has been conducted in 38 morbidly obese patients to compare jejunoileal bypass (19 patients) with gastric bypass (19 patients). At this point the patients have been followed up for periods of from 1 month to 2 years, and 12 patients in each surgical group have been observed for 6 months or longer after operation. There was one death among the 38 patients, a woman with a gastric bypass who developed a pulmonary embolus 22 days postoperatively. Gastric bypass resulted in somewhat greater weight loss than jejunoileal bypass. Although the follow-up period has been short, jejunoileal bypass has resulted in greater morbidity and expense to the patient than gastric bypass. In particular, gastric bypass did not cause progression of liver lesions in any of the 6 patients who had liver biopsies 1 year postoperatively, while jejunoileal bypass was associated with development of fatty metamorphosis in the liver of 3 patients after 1 year. The entry of new patients into the clinical trial has been discontinued because we believe there is sufficient evidence to indicate that gastric bypass is superior to jejunoileal bypass in the treatment of morbid obesity.

Résumé

Nous avons réalisé un essai clinique prospectif et randomisé destiné à comparer le court-circuit jéjunoiléal (19 cas) et le court-circuit gastrique (19 cas) comme traitement de l'obésité grave chez 38 patients. Actuellement, les malades ont été suivis pendant 1 mois à 2 ans et 12 patients dans chaque groupe ont pu être observés pendant plus de 6 mois après l'intervention. Il y eut un décès, une femme qui mourut d'embolie pulmonaire 22 jours après avoir subi un court-circuit gastrique. Le by-pass gastrique entraîne une perte de poids un peu plus importante que le court-circuit jéjuno-iléal. Quoique la période d'observation soit courte, il apparaît que les courtcircuits jéjuno-iléaux sont grevés d'une plus grande morbidité que les by-pass gastriques. En particulier, le by-pass gastrique n'a pas entraîné de progression des lésions hépatiques chez les 6 malades qui ont subi une biopsie hépatique un an après l'intervention alors que le by-pass jéjuno-iléal s'est accompagné de métamorphose graisseuse chez 3 patients au bout d'un an. Nous avons arrêté cet essai thérapeutique contrôlé parce que nous croyons qu'il existe des preuves suffisantes de la supériorité du by-pass gastrique dans le traitement de l'obésité grave.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Buchwald, H., Schwartz, M.Z., Varco, R.L.: Surgical treatment of obesity. Adv. Surg.7:235, 1973

    Google Scholar 

  2. Kremen, A.N., Linner, J.H., Nelson, C.H.: An experimental evaluation of the nutritional importance of proximal and distal small intestine. Ann. Surg.140:439, 1954

    Google Scholar 

  3. Payne, J.H., DeWind, L.T., Commons, R.R.: Metabolic observations in patients with jejunocolic shunts. Am. J. Surg.106:273, 1963

    Google Scholar 

  4. Bondar, G.F., Pisesky, W.: Complications of small intestinal short circuiting for obesity. Arch. Surg.94:707, 1967

    Google Scholar 

  5. DeMuth, W.E., Rottenstein, H.S.: Death associated with hypocalcemia after small bowel short circuiting. N. Engl. J. Med.270:1239, 1964

    Google Scholar 

  6. Editorial: Complications of intestinal bypass for obesity. J.A.M.A.200:638, 1967

  7. Wood, L.C., Chremos, A.N.: Treating obesity by “short circuiting” the small intestine. J.A.M.A.186:63, 1963

    Google Scholar 

  8. Payne, J.H., DeWind, L.T.: Surgical treatment of obesity. Am. J. Surg.118:141, 1969

    Google Scholar 

  9. Salmon, P.A.: The results of small intestinal bypass operations for the treatment of obesity. Surg. Gynecol. Obstet.132:965, 1971

    Google Scholar 

  10. Scott, H.W., Dean, R., Shull, H.J., Abram, H.S., Webb, W., Younger, R.H., Brill, A.B.: New considerations in use of jejunoileal bypass in patients with morbid obesity. Ann. Surg.177:723, 1973

    Google Scholar 

  11. Scott, H.W., Dean, R.H., Shull, H.J., Gluck, F.W., Abram, H.S., Webb, W., Brill, A.B., Price, R.R.: Surgical management of morbid obesity: current considerations in the use of extensive jejunoileal bypass. South. Med. J.69:789, 1976

    Google Scholar 

  12. Buchwald, H., Varco, R.L., Moore, R.B., Schwartz, M.Z.: Intestinal bypass procedures. Curr. Probl. Surg. April, 1975

  13. Mason, E.E., Ito, C.: Gastric bypass in obesity. Surg. Clin. North Am.47:1345, 1967

    Google Scholar 

  14. Mason, E.E., Printen, K.J., Hartford, C.E., Boyd, W.C.: Optimizing results of gastric bypass. Ann. Surg.182:405, 1975

    Google Scholar 

  15. Hermreck, A.S., Jewell, W.R., Hardin, C.A.: Gastric bypass for morbid obesity: results and complications. Surgery80:498, 1976

    Google Scholar 

  16. Hornberger, H.R.: Gastric bypass. Am. J. Surg.131:415, 1976

    Google Scholar 

  17. Mason, E.E., Gordy, D.D., Chernigoy, F.A., Printen, K.J.: Fatty acid toxicity. Surg. Gynecol. Obstet.133:992, 1971

    Google Scholar 

  18. Passaro, E., Drenick, E., Wilson, S.E.: Bypass enteritis. Am. J. Surg.131:169, 1976

    Google Scholar 

  19. Benfield, J.R., Greenway, F.L., Bray, G.A., Barry, R.E., Lechago, J., Mena, I., Schedewie, H.: Experience with jejunoileal bypass for obesity. Surg. Gynecol. Obstet.143:401, 1977

    Google Scholar 

  20. Four Steps to Weight Control, Metropolitan Life Insurance Co., p. 12, 1969

  21. Printen, K.J., Mason, E.E.: Gastric bypass for morbid obesity in patients more than fifty years of age. Surg. Gynecol. Obstet.144:192, 1977

    Google Scholar 

  22. DeWind, L.T., Payne, J.H.: Intestinal bypass surgery for morbid obesity. J.A.M.A.236:2298, 1976

    Google Scholar 

  23. Winkleman, E.I.: Bypass operation loses favor in obesity treatment. Medical News. J.A.M.A.236:2729, 1976

    Google Scholar 

  24. Bray, G.A., Barry, R.E., Benfield, J.R., Castelnuovo-Tedesco, P., Drenick, E.J., Passaro, E.: Intestinal bypass operation as a treatment for obesity. Ann. Intern. Med.85:97, 1976

    Google Scholar 

  25. Buchwald, H., Lober, P.H., Varco, R.L.: Liver biopsy findings in seventy-seven consecutive patients undergoing jejunoileal bypass for morbid obesity. Am. J. Surg.127:48, 1974

    Google Scholar 

  26. Salmon, P.A., Reedyk, L.: Fatty metamorphosis in patients with jejunoileal bypass. Surg. Gynecol. Obstet.141:75, 1975

    Google Scholar 

  27. Cegielski, M.M., Organ, C.H., Saporta, J.A.: Revision of intestinal bypass procedures. Surg. Gynecol. Obstet.142:829, 1976

    Google Scholar 

  28. Mason, E.E., Printen, K.J.: Metabolic considerations in reconstitution of the small intestine after jejunoileal bypass. Surg. Gynecol. Obstet.142:177, 1976

    Google Scholar 

  29. Hitchcock, C.T., Jewell, W.R., Hardin, CA., Hermreck, A.S.: Management of the morbidly obese patient after small bowel bypass failure. Surgery82:356, 1977

    Google Scholar 

  30. O'Leary, J.P., Thomas, W.C., Woodward, E.R.: Urinary tract stone after small bowel bypass for morbid obesity. Am. J. Surg.127:142, 1974

    Google Scholar 

  31. Wands, J.R., LaMont, J.T., Mann, E., Isselbacher, K.J.: Arthritis associated with intestinal bypass procedure for morbid obesity. N. Engl. J. Med.294:121, 1976

    Google Scholar 

  32. Griffen, W.O., Young, L., Stevensen, C.C.: A prospective comparison of gastric and jejunoileal bypass procedures for morbid obesity. Ann. Surg.186: 500, 1977

    Google Scholar 

  33. Iber, F.L., Cooper, M.: Jejunoileal bypass for the treatment of massive obesity. Prevalence, morbidity, and short- and long-term consequences. Am. J. Clin. Nutr.30:4, 1977

    Google Scholar 

  34. Alden, J.F.: Gastric and- jejunoileal bypass. Arch. Surg.112: 799, 1977

    Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Surgery, North Carolina Memorial Hospital and University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA

    Joseph A. Buckwalter M.D.

Authors
  1. Joseph A. Buckwalter M.D.
    View author publications

    You can also search for this author in PubMed Google Scholar

Additional information

Supported by Public Health Service Research Grant No. RR-46, from the General Clinical Research Centers Branch of the Division of Research Resources.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Buckwalter, J.A. A prospective comparison of the jejunoileal and gastric bypass operations for morbid obesity. World J. Surg. 1, 757–766 (1977). https://doi.org/10.1007/BF01555933

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01555933

Keywords

Search

Navigation