Treatment of jejunoileal bypass failure by reanastomosis and gastroplasty in a single-stage procedure. Review of 47 cases.
Jejunoileal bypass (JIB) for morbid obesity has resulted in a variety of metabolic complications requiring reanastomosis. Although reversal of JIB is usually effective in resolving the metabolic problems, weight gain to pre-JIB levels is common. A single-stage operation combining JIB reversal with gastroplasty (RGP) was performed on 47 patients to correct metabolic complications associated with JIB and reduce recurrence of morbid obesity. Mean follow-up time was 20 months with a range of 6 to 37 months. Average weight at the time of revision was 81 kg, 16.6 kg above the mean ideal weight. Approximately 96 per cent of complications leading to reversal were resolved. Mean postoperative weights showed a gradual increase up to 2 years, at which time weight gain stabilized. Patients 2 to 3 years postsurgery average 36.4 kg above ideal weight and 19.8 kg above weight at the time of reversal. Approximately 79 per cent of patients remained below morbid obesity levels. Complications included eight cases of stomal obstruction; two required reoperation. Stomal dilatation was identified in two patients. There were no mortalities. RGP was found to be ineffective in producing weight loss in patients who had not lost significant weight following JIB. This study suggests that JIB reversal with gastroplasty as a single procedure is safe and effective in resolving nearly all JIB complications. RGP is associated with gradual increase in weight for 2 years, after which weight gain appears to plateau. However, return to morbid obesity levels can be prevented in 70 per cent of patients undergoing RGP.
D000328:Adult; D001835:Body Weight; D005260:Female; D006801:Humans; D007082:Ileum / Q000601:surgery*; D007583:Jejunum / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000628:therapy*; D011183:Postoperative Complications; D012008:Recurrence; D012086:Reoperation; D013270:Stomach / Q000601:surgery*