LONG-TERM MORBIDITY FOLLOWING JEJUNOILEAL BYPASS - THE CONTINUING POTENTIAL NEED FOR SURGICAL REVERSAL

Objective: To review the late sequelae of jejunoileal bypass (JIB) and the potential role of late surgical reversal in ameliorating morbidit y and mortality following JIB. Design: Patients who underwent JIB betw een 1965 and 1977 were contacted and pertinent health-event informatio n was gathered. Early sequelae were defined as disorders occurring wit hin the first 2 years after JIB; late sequelae were those occurring af ter 2 years. Health events occurring between 0 and 23 years after JIB were documented. Setting: A private, tertiary referral center. Patient s: Patients underwent JIB for morbid obesity that had failed medical a nd/or psychiatric interventions. Main Outcome Measures: Body mass inde x (BMI) (weight in kilograms divided by the square of the height in me ters), diarrhea, electrolyte imbalance, acute and chronic liver diseas e, renal disease, JIB reversal, reason for JIB reversal, death, and ca use of death. Results: A total of 453 morbidly obese patients underwen t JIB. By 2 years following JIB, the mean (+/-SD) BMI dropped from 49. 3+/-8.1 to 31.1+/-0.8 and remained at this level until year 15, after which weight gradually increased (BMI, 35.4+/-3.1). The most severe ea rly complication was acute liver failure, which occurred in 7% of pati ents and caused seven deaths., At 15 years, the actuarial probability of the most common serious late complications related to JIB were rena l disease (37%), with two deaths; diarrhea (29%); and liver disease (1 0%), with three deaths. One hundred thirty-tight patients (31%) had a bypass reversal. The most common indications for reversal were diarrhe a and electrolyte disturbance (29%), renal disease (19%), and liver di sease (17%). Fifty-six patients died more than 30 days after JIB: 64% before JIB reversal, 13% at the time of reversal, and 23% subsequently . Conclusions: Jejunoileal bypass is associated with progressive accru al of serious, sometimes life-threatening complications. Lifelong foll ow-up for early diagnosis and surgical reversal before life is threate ned should reduce the morbidity and mortality associated with this pro cedure.