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Modified Jejunoileal Bypass Surgery with Biliary Diversion for Morbid Obesity and Changes in Liver Histology During Follow-up

  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and aims

Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications including rapid progress of liver disease. The senior author (I.F.) has developed a modification of jejunoileal bypass, which we believe overcomes many of the shortcomings of the classic procedure.

Methods

Consecutive patients referring for bariatric surgery were included. A modified jejunoileal bypass in which the defunctionalized limb is eliminated by anastomosing its ends to the gall bladder and cecum was performed. Liver biopsies were taken during operation and at a mean of 16 months later. The patients were followed for 5 years.

Results

Forty-three patients were enrolled. The mean value of weight and body mass index (BMI) fell from 128 kg and 46 kg/m2 before operation to 85 kg and 31 kg/m2 at 5 years, respectively (p < 0.001). There was no significant change in the degree of liver steatosis and necroinflammation. The mean liver fibrosis score increased from 0.1 to 0.9 (p = 0.015). No sign of advanced liver disease was observed during the 5-year follow-up.

Conclusion

The modified jejunoileal bypass is very effective in inducing and maintaining weight loss for 5 years and does not lead to hepatic failure or rapid progression of liver disease.

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References

  1. Malekzadeh R, Mohamadnejad M, Merat S, Pourshams A, Etemadi A. Obesity pandemic: an Iranian perspective. Archives of Iranian Medicine 2005;8:1–7.

    Google Scholar 

  2. Bahrami H, Sadatsafavi M, Pourshams A, Kamangar F, Nouraie M, Semnani S, Brennan P, Boffetta P, Malekzadeh R. Obesity and hypertension in an Iranian cohort study; Iranian women experience higher rates of obesity and hypertension than American women. BMC Public Health 2006;6:158.

    Article  PubMed  Google Scholar 

  3. Lara MD, Kothari SN, Sugerman HJ. Surgical management of obesity: a review of the evidence relating to the health benefits and risks. Treatments in Endocrinol 2005;4:55–64.

    Article  Google Scholar 

  4. Klein S, Mittendorfer B, Eagon JC, Patterson B, Grant L, Feirt N, Seki E, Brenner D, Korenblat K, McCrea J. Gastric bypass surgery improves metabolic and hepatic abnormalities associated with nonalcoholic fatty liver disease. Gastroenterology 2006;130:1564–1572.

    Article  PubMed  CAS  Google Scholar 

  5. Mottin CC, Moretto M, Padoin AV, Kupski C, Swarowsky AM, Glock L, Duval V, da Silva JB. Histological behavior of hepatic steatosis in morbidly obese patients after weight loss induced by bariatric surgery. Obes Surg 2005;15:788–793.

    Article  PubMed  Google Scholar 

  6. Gastrointestinal surgery for severe obesity. NIH consensus development conference, March 25–27,1991. Nutrition 1996;12:397–404.

    Google Scholar 

  7. Brolin RE. Update: NIH consensus conference. Gastrointestinal surgery for severe obesity. Nutrition 1996;12:403–404.

    Article  PubMed  CAS  Google Scholar 

  8. Schneider BE, Mun EC. Surgical management of morbid obesity. Diabetes Care 2005;28:475–480.

    Article  PubMed  Google Scholar 

  9. Holzbach RT. Hepatic effects of jejunoileal bypass for morbid obesity. Am J Clin Nutr 1977;30:43–52.

    PubMed  CAS  Google Scholar 

  10. Moxley RT, III, Pozefsky T, Lockwood DH. Protein nutrition and liver disease after jejunoileal bypass for morbid obesity. N Engl J Med 1974;290:921–926.

    Article  PubMed  Google Scholar 

  11. Geiss DM, Shields S, Watts JD. Reversibility of hepatic failure following jejunoileal bypass. Arch Surg 1976;111:1362–1365.

    PubMed  CAS  Google Scholar 

  12. Dean P, Joshi S, Kaminski DL. Long-term outcome of reversal of small intestinal bypass operations. Am J Surg 1990;159:118–123.

    Article  PubMed  CAS  Google Scholar 

  13. Styblo T, Martin S, Kaminski DL. The effects of reversal of jejunoileal bypass operations on hepatic triglyceride content and hepatic morphology. Surgery 1984;96:632–641.

    PubMed  CAS  Google Scholar 

  14. Ishak K, Baptista A, Bianchi L, Callea F, De Groote J, Gudat F, Denk H, Desmet V, Korb G, MacSween RN. Histological grading and staging of chronic hepatitis. J Hepatol 1995;22:696–699.

    Article  PubMed  CAS  Google Scholar 

  15. Hamilton DL, Vest TK, Brown BS, Shah AN, Menguy RB, Chey WY. Liver injury with alcoholiclike hyalin after gastroplasty for morbid obesity. Gastroenterology 1983;85:722–726.

    PubMed  CAS  Google Scholar 

  16. Reid AE. Nonalcoholic steatohepatitis. Gastroenterology 2001;121:710–723.

    Article  PubMed  CAS  Google Scholar 

  17. Angulo P. Nonalcoholic fatty liver disease. N Engl J Med 2002;346:1221–1231.

    Article  PubMed  CAS  Google Scholar 

  18. Yang SQ, Lin HZ, Lane MD, Clemens M, Diehl AM. Obesity increases sensitivity to endotoxin liver injury: Implications for the pathogenesis of steatohepatitis. Proc Natl Acad Sci USA 1997;94:2557–2562.

    Article  PubMed  CAS  Google Scholar 

  19. Mezey E, Imbembo AL, Potter JJ, Rent KC, Lombardo R, Holt PR. Endogenous ethanol production and hepatic disease following jejunoileal bypass for morbid obesity. Am J Clin Nutr 1975;28:1277–1283.

    PubMed  CAS  Google Scholar 

  20. Wigg AJ, Roberts-Thomson IC, Dymock RB, McCarthy PJ, Grose RH, Cummins AG. The role of small intestinal bacterial overgrowth, intestinal permeability, endotoxaemia, and tumour necrosis factor alpha in the pathogenesis of non-alcoholic steatohepatitis. Gut 2001;48:206–211.

    Article  PubMed  CAS  Google Scholar 

  21. Shaffer EA. Bariatric surgery: a promising solution for nonalcoholic steatohepatitis in the very obese. J Clin Gastroenterol 2006;40:S44–S50.

    Article  PubMed  Google Scholar 

  22. Scopinaro N. Biliopancreatic diversion: mechanisms of action and long-term results. Obes Surg 2006;16:683–689.

    Article  PubMed  Google Scholar 

  23. Hess DS, Hess DW. Biliopancreatic diversion with a duodenal switch. Obes Surg 1998;8:267–282.

    Article  PubMed  CAS  Google Scholar 

  24. Guedea ME, Arribas dA, Solanas JA, Marco CA, Bernado AJ, Rodrigo MA, Diago VA, Diez MM. Results of biliopancreatic diversion after five years. Obes Surg 2004;14:766–772.

    Article  PubMed  Google Scholar 

  25. Bouldin MJ, Ross LA, Sumrall CD, Loustalot FV, Low AK, Land KK. The effect of obesity surgery on obesity comorbidity. Am J Med Sci 2006;331:183–193.

    Article  PubMed  Google Scholar 

  26. Stratopoulos C, Papakonstantinou A, Terzis I, Spiliadi C, Dimitriades G, Komesidou V, Kitsanta P, Argyrakos T, Hadjiyannakis E. Changes in liver histology accompanying massive weight loss after gastroplasty for morbid obesity. Obes Surg 2005;15:1154–1160.

    Article  PubMed  Google Scholar 

  27. Kral JG, Thung SN, Biron S, Hould FS, Lebel S, Marceau S, Simard S, Marceau P. Effects of surgical treatment of the metabolic syndrome on liver fibrosis and cirrhosis. Surgery 2004;135:48–58.

    Article  PubMed  Google Scholar 

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Author information

Authors and Affiliations

  1. Department of Surgery, Medical School, Shahid Beheshti University of Medical Sciences, P.O. Box 19395/4655, Tehran, Iran

    Iraj Fazel

  2. Digestive Disease Research Center, Shariati Hospital, Medical Sciences/University of Tehran, Tehran, Iran

    Akram Pourshams, Shahin Merat, Roya Hemayati, Masoud Sotoudeh & Reza Malekzadeh

Authors
  1. Iraj Fazel
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  2. Akram Pourshams
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  3. Shahin Merat
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  4. Roya Hemayati
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  5. Masoud Sotoudeh
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  6. Reza Malekzadeh
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Corresponding author

Correspondence to Iraj Fazel.

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Fazel, I., Pourshams, A., Merat, S. et al. Modified Jejunoileal Bypass Surgery with Biliary Diversion for Morbid Obesity and Changes in Liver Histology During Follow-up. J Gastrointest Surg 11, 1033–1038 (2007). https://doi.org/10.1007/s11605-007-0184-1

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  • DOI: https://doi.org/10.1007/s11605-007-0184-1

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