Cirugia bariatrica

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Online Submissions: doi:10.3748/wjg.15.2277

© 2009 The WJG Press and Baishideng. All rights reserved.

World J Gastroenterol 2009 May 14; 15(18): 2277-2279 World Journal of Gastroenterology ISSN 1007-9327


Jejunoileal bypass: A surgery of the past and a review of its complications

Dushyant Singh, Alexandra S Laya, Wendell K Clarkston, Mark JAllen
Dushyant Singh, Alexandra S Laya, Wendell K Clarkston, Mark J Allen, Department of Gastroenterology and Hepatology, University of Missouri Kansas City, Kansas City MO 64111, United States Author contributions: Singh D conceived the idea; Singh D wrote the paper; Laya AS developed the tables and edited the figures; Allen MJ and Clarkston WK analyzed the paper and revised it critically forimportant intellectual content; Clarkston WK provided the funding. Correspondence to: Dushyant Singh, MD, Department of Gastroenterology and Hepatology, 5525 Brownridge Dr, Shawnee, KS 66218, United States. Telephone: +1-913-9483935 Fax: +1-816-9325179 Received: October 30, 2008 Revised: February 23, 2009 Accepted: March 2, 2009 Published online: May 14, 2009

INTRODUCTIONBariatric surgery is one of the few proven methods that cause durable weight loss. Failure of conservative means of producing permanent weight reduction in patients with morbid obesity, led to the introduction of operative approaches, such as jejunoileal bypass (JIB), which became popular in the late 1960s and early 1970s[1]. At that time, JIB was the most effective surgical intervention for achievingand maintaining weight loss. Typically, 35 centimeters of proximal jejunum was anastamosed, end-to-side or end-to-end, to the terminal 10 centimeters of ileum[2] (Figure 1). It was presumed that patients undergoing this procedure would experience continued hyperphagia, but would accomplish weight loss due to malabsorption[3]. As a result of JIB, patients whose preoperative weight was over 157 kglost a mean of 58 kg at the end of 1 year[2]. However, JIB surgery has long been abandoned as a method of weight reduction surgery because of serious short and long-term complications. The number of patients who currently retain a jejunoileal bypass is small, as most patients have died or undergone reversal of their operation or conversion to a different bariatric procedure [3]. Recognition ofprevious JIB and understanding of its metabolic consequences are essential in the proper management of these patients.

Jejunoileal bypass (JIB), popular in the 1960s and 1970s, had remarkable success in achieving weight loss by creating a surgical short bowel syndrome. Our patient had an unusual case of liver disease and provided no history of prior bariatric surgery. Later, it wasrecognized that he had a JIB in the 1970s, which was also responsible for the gamut of his illnesses. Patients with JIB are often not recognized, as they died of complications, or underwent reversal of their surgery or a liver-kidney transplant. Early identification with prompt reversal, and the recognition and treatment of the life-threatening consequences play a critical role in the management of suchpatients.
© 2009 The WJG Press and Baishideng. All rights reserved.

A 64-year-old male was admitted on a regular basis for tense ascites (requiring serial large volume paracentesis) attributed to underlying advanced liver disease of unclear etiology. It was presumed to be the result of steatohepatitis from nonalcoholic fatty liver disease and/ or chronic hepatic congestion due todecreased cardiac function. The patient had a prior history of morbid obesity (191 kg, BMI 62) and cholecystectomy. His physical examination was remarkable for jaundice, abdominal ascites, spider angioma in the upper chest, gynecomastia and splenomegaly. He had numerous other medical problems including multiple kidney stones with three previous lithotripsy interventions, progressive kidney...
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