This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in this journal  Social Bookmarking   What's this?

The Continuing Potential Need for Surgical Reversal

Jay A. Requarth, MD; Kenneth W. Burchard, MD; Thomas A. Colacchio, MD; Therese A. Stukel, PhD; Leila A. Mott, MS; E. Robert Greenberg, MD; Rodger E. Weismann, MD

Arch Surg. 1995;130(3):318-325.

Abstract
Objective
To review the late sequelae of jejunoileal bypass (JIB) and the potential role of late surgical reversal in ameliorating morbidity and mortality following JIB.

Design
Patients who underwent JIB between 1965 and 1977 were contacted and pertinent health-event information was gathered. Early sequelae were defined as disorders occurring within the first 2 years after JIB; late sequelae were those occurring after 2 years. Health events occurring between () and 23 years after JIB were documented.

Setting
A private, tertiary referral center.

Patients
Patients underwent JIB for morbid obesity that had failed medical and/or psychiatric interventions.

Main Outcome Measures
Body mass index (BMI) (weight in kilograms divided by the square of the height in meters), diarrhea, electrolyte imbalance, acute and chronic liver disease, renal disease, JIB reversal, reason for JIB reversal, death, and cause of death.

Results
A total of 453 morbidly obese patients underwent JIB. By 2 years following JIB, the mean (±SD) BMI dropped from 49.3±8.1 to 31.1±0.8 and remained at this level until year 15, after which weight gradually increased (BMI, 35.4±3.1). The most severe early complication was acute liver failure, which occurred in 7% of patients and caused seven deaths. At 15 years, the actuarial probability of the most common serious late complications related to JIB were renal disease (37%), with two deaths; diarrhea (29%); and liver disease (10%), with three deaths. One hundred thirty-eight patients (31%) had a bypass reversal. The most common indications for reversal were diarrhea and electrolyte disturbance (29%), renal disease (19%), and liver disease (17%). Fifty-six patients died more than 30 days after JIB: 64% before JIB reversal, 13% at the time of reversal, and 23% subsequently.

Conclusions
Jejunoileal bypass is associated with progressive accrual of serious, sometimes life-threatening complications. Lifelong follow-up for early diagnosis and surgical reversal before life is threatened should reduce the morbidity and mortality associated with this procedure.

(Arch Surg. 1995;130:318-325)

Author Affiliations
From the Section of General Surgery, Department of Surgery (Drs Requarth, Burchard, Colacchio, and Weismann), and the Section of Biostatistics and Epidemiology, Department of Community and Family Medicine and Norris Cotton Cancer Center (Drs Stukel and Greenberg and Ms Mott), Dartmouth-Hitchcock Medical Center, Lebanon, NH. Dr Requarth is now in private practice in Charleston, WVa.

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Oxalate Nephropathy Complicating Roux-en-Y Gastric Bypass: An Underrecognized Cause of Irreversible Renal Failure
Nasr et al.
CJASN 2008;3:1676-1683.
ABSTRACT | FULL TEXT  

Imaging in Bariatric Surgery: A Guide to Postsurgical Anatomy and Common Complications
Chandler et al.
Am. J. Roentgenol. 2008;190:122-135.
ABSTRACT | FULL TEXT  

Surgery for morbid obesity
Bennett et al.
Postgrad. Med. J. 2007;83:8-15.
ABSTRACT | FULL TEXT  

D-Lactic Acidosis
Petersen
Nutr Clin Pract 2005;20:634-645.
ABSTRACT | FULL TEXT  

Surgical Management of Morbid Obesity
Schneider and Mun
Diabetes Care 2005;28:475-480.
FULL TEXT  

Hepatic granulomas: a 10 year single centre experience
Gaya et al.
J. Clin. Pathol. 2003;56:850-853.
ABSTRACT | FULL TEXT