Modified jejunoileal bypass surgery with biliary diversion for morbid obesity and changes in liver histology during follow-up.
OBJECTIVE
Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications including rapid progress of liver disease. The senior author (I.F.) has developed a modification of jejunoileal bypass, which we believe overcomes many of the shortcomings of the classic procedure.


METHODS
Consecutive patients referring for bariatric surgery were included. A modified jejunoileal bypass in which the defunctionalized limb is eliminated by anastomosing its ends to the gall bladder and cecum was performed. Liver biopsies were taken during operation and at a mean of 16 months later. The patients were followed for 5 years.


RESULTS
Forty-three patients were enrolled. The mean value of weight and body mass index (BMI) fell from 128 kg and 46 kg/m(2) before operation to 85 kg and 31 kg/m(2) at 5 years, respectively (p < 0.001). There was no significant change in the degree of liver steatosis and necroinflammation. The mean liver fibrosis score increased from 0.1 to 0.9 (p = 0.015). No sign of advanced liver disease was observed during the 5-year follow-up.


CONCLUSIONS
The modified jejunoileal bypass is very effective in inducing and maintaining weight loss for 5 years and does not lead to hepatic failure or rapid progression of liver disease.
Fazel
Iraj
I
Department of Surgery, Medical School, Shahid Beheshti University of Medical Sciences, P.O. Box 19395/4655, Tehran, Iran. fazel@ams.ac.ir
Pourshams
Akram
A
Merat
Shahin
S
Hemayati
Roya
R
Sotoudeh
Masoud
M
Malekzadeh
Reza
R
D000293:Adolescent; D000328:Adult; D000368:Aged; D015904:Biliopancreatic Diversion; D002648:Child; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007581:Jejunoileal Bypass / Q000379:methods*; D008099:Liver / Q000473:pathology*; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery*