GASTRIC OBESITY SURGERY COMBINED WITH PARTIAL ILEAL BYPASS FOR HYPERCHOLESTEROLEMIA

Background: It is unusual for a patient to manifest both morbid obesit y and hyperlipidemia. Certain of these individuals may also have a his tory of hypertriglyceridemic pancreatitis. We report six morbidly obes e hypercholesterolemic patients, two with recurrent hypertriglyceridem ic pancreatitis, who were managed by concurrent gastric restrictive su rgery and a partial ileal bypass operation. Methods: The first dual pr ocedure was performed on January 6 1992, and the most recent on Februa ry 20 1997. Our series consists of two males and four females, with an average age of 35.5 years at the time of surgery. The mean preoperati ve weight of these patients was 116.8 kg, and the mean BMI was 39.7kg/ m(2). The preoperative mean total plasma cholesterol was 5.5 g/l and t he mean plasma triglyceride was 30.61 g/l; the two patients with a his tory of hypertriglyceridemic pancreatitis had plasma triglyceride leve ls of 33.6 g/l and 65 g/l. Results: The average weight reduction, usin g available follow-up intervals was 40.3 kg (34.5%), with a mean posto perative BMI of 20.0 kg/m(2) (34.8% reduction). The markedly elevated total plasma cholesterol and plasma triglyceride levels were normalize d, with a postoperative mean total plasma cholesterol of 1.47 g/l (73. 3% reduction) and a concomitant mean plasma triglyceride of 1.63 g/l ( 94.7% reduction). The two patients with a history of pancreatitis sust ained triglyceride reductions of 96.5% and 94.1%, and neither patient has had an episode of pancreatitis following the dual operative proced ures. Conclusion: We conclude that the combination of a gastric restri ctive operation with a partial ileal bypass procedure represents excel lent management for patients with both morbid obesity and hypercholest erolemia, especially if the hypercholesterolemia is accompanied by hyp ertriglyceridemic pancreatitis.