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[20 years small intestinal bypass surgery. What is left?].
1Chirurgische Klinik, Dominikus-Krankenhaus, Düsseldorf.
Summary
Jejunoileostomy effectively reduced weight by 50-60 kg in morbidly obese patients but led to frequent complications. This led to its abandonment in favor of newer bariatric surgeries.
Area of Science:
- Bariatric Surgery
- Gastroenterology
- Surgical History
Context:
- From 1970-1980, jejunoileostomy was a common bariatric procedure for severe obesity (grade III).
- The surgery demonstrated significant initial weight loss (50-60 kg in 18 months) and improved obesity-related comorbidities.
- However, it was associated with frequent and severe complications.
Purpose:
- To evaluate the efficacy and complications of jejunoileostomy in morbidly obese patients.
- To understand the reasons for the procedure's decline in popularity.
- To identify potential niche applications for jejunoileostomy.
Summary:
- Jejunoileostomy resulted in substantial weight loss and improvement in obesity-related issues for 288 patients.
- Common complications included chronic electrolyte/protein/vitamin loss, diarrhea, perianal issues, renal stones, cholelithiasis, and blind loop syndrome.
- Frequent reoperations were required, leading to the procedure being superseded by vertical banded gastroplasty and adjustable gastric bands.
Impact:
- Jejunoileostomy's high complication rate led to its discontinuation as a primary bariatric procedure.
- The historical data informs current bariatric surgery practices and patient selection.
- Jejunoileostomy may still be considered in select cases where gastric restriction methods have failed.