Favourable Long-term Results with the End-to-Side Jejunoileal Bypass

Background: Although jejunoileal bypass (JIB) causes longstanding weight loss, it is no longer recommended as a surgical treatment of morbid obesity due to adverse effects. Methods: JIB was performed on 87 morbidly obese subjects with a mean age of 35 years. Complete followup on 95% of the patients included monitoring weight, metabolic parameters and liver biopsies up to 25 years postoperatively. Results: The mean (± sd) Body Mass Index (BMI) was reduced from 41.5 ± 5.8 kg m⁻² preoperative, to 26.7 ± 3.8 kg m⁻² at 2 years and 29.7 ± 3.9 kg m⁻² at 16 years follow-up. More than 60% loss of initial excess weight was achieved by 88% of the patients at four years and by 75% at 16 years follow-up. Reversal of the bypass was performed in 3% of the patients and revisions in 8% of the patients. There was no 30-day hospital mortality but there was one (1%) late bypass-related death. Complications included urinary calculi in 39% of the patients, electrolyte disturbances in 25% and transient liver failure in 5.5%. Liver biopsies taken more than 13 years postoperatively in 44 patients revealed no cirrhosis. All patients were normoglycemic and normolipemic at follow-up. Conclusions: The majority of the patients have an acceptable weight reduction, few serious adverse effects but several beneficial effects after more than 16 years. The JIB deserves a reconsideration as an alternative in obesity surgery.