Long-term morbidity following jejunoileal bypass. The continuing potential need for surgical reversal
J. A. Requarth, K. W. Burchard, T. A. Colacchio, T. A. Stukel, L. A. Mott, E. R. Greenberg and R. E. Weismann
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, NH.
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 0 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
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 morbidity 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.
