REVERSAL OF SMALL-INTESTINAL BYPASS OPERATIONS AND CONCOMITANT VERTICAL BANDED GASTROPLASTY - LONG-TERM OUTCOME

BACKGROUND: Long-term complications of jejunoileal bypass (TIE) have b een reported, prompting restoration of intestinal continuity and conco mitant performance of vertical banded gastroplasty (VBG) for weight co ntrol. The aim of this study was to evaluate the presentation and reve rsal of JIB complications, late complications, mortality, and long-ter m weight control in patients who have undergone JIB reversal and conco mitant VBG. STUDY DESIGN: From 1981 to 1994, 37 patients were treated for complications from JIB that included diarrhea (73 percent), arthri tis (46 percent), malnutrition (22 percent), urolithiasis (19 percent) , electrolyte disorders (19 percent), and lack of weight loss (8 perce nt). Four patients required preoperative parenteral nutrition to corre ct protein and electrolyte imbalances. Surgical management of all 37 p atients included restoration of bowel continuity and VBG during the sa me operative procedure. RESULTS: Postoperative complications occurred in 11 patients, including prolonged ileus in seven patients, pancreati tis in three patients, and infectious complications in two. There were no deaths. Late morbidity included staple line dehiscence in four pat ients, incisional hernia in three patients, and reversal of the VBG in one. Ah patients with diarrhea, malnutrition, electrolyte disorders, and lack of weight loss had resolution of their symptoms, while urolit hiasis and arthritis resolved in 86 and 53 percent of patients, respec tively. In patients available for five-year follow-up evaluation, weig ht changes were small, shifting from a preoperative weight of 87 +/- 1 9 to 90 +/- 19 kg at five years (mean +/- SD). CONCLUSIONS: Restoratio n of intestinal continuity combined with VBG is a safe and effective o peration that will reverse most of the long-term complications of JIB and provide stable weight control for up to five years.