FAVORABLE LONG-TERM RESULTS WITH THE END-TO-SIDE JEJUNOILEAL BYPASS

Background: Although jejunoileal bypass (JIB) causes longstanding weig ht loss, it is no longer recommended as a surgical treatment of morbid obesity due to adverse effects. Methods: JIB was performed on 87 morb idly obese subjects with a mean age of 35 years. Complete followup on 95% of the patients included monitoring weight, metabolic parameters a nd liver biopsies up to 25 years postoperatively. Results: The mean(so) Body Mass Index (BMI) was reduced from 41.5 +/- 5.8 kg m(-2) preop erative, 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 wa s 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 mor tality but there was one (1%) late bypass-related death. Complications included urinary calculi in 39% of the patients, electrolyte disturba nces in 25% and transient liver failure in 5.5%. Liver biopsies taken more than 13 years postoperatively in 44 patients revealed no cirrhosi s. All patients were normoglycemic and normolipemic at follow-up. Conc lusions: The majority of the patients have an acceptable weight reduct ion, few serious adverse effects but several beneficial effects after more than 16 years. The JIB deserves a reconsideration as an alternati ve in obesity surgery.