Conversion of Jejunoileal Bypass to Silastic Ring Vertical Gastroplasty

A gastric restrictive procedure is usually performed simultaneous with takedown of a jejunoileal bypass (JIB) to prevent weight regain. However, the preferred gastric restrictive procedure has not been established. Currently, we combine JIB takedown with silastic ring vertical gastroplasty (SRVG), and report our experience with 36 patients treated over a 5-year period. Indications for JIB takedown were diarrhea (69%), arthralgias (53%), liver disease (34%), nephrolithiasis (25%), and increasing weight (33%). Mean weight at the time of JIB takedown was 232+/-12 (SEM) lb (105 +/- 5 kg) (77 +/- 8% EBW (excess body weight)). Follow-up was complete in 33 (92%) patients. Post-reversal weight was 202 +/- 14 lb (92 +/- 6 kg) (55 +/- 8% EBW) at 1 year and 218 +/- 12 lb (99 +/- 5 kg) (67 +/- 8% EBW) (not significant) at a mean follow-up of 2.9 years. Twenty-one (64%) patients lost weight or were stable (+/-% EBW), while 12 (36%) gained a mean of 39 +/- 7 lb (18 +/- 3 kg) (range 16-80 lb (7 +/- 36 kg)). Resolution of preoperative complaints was noted in all patients with diarrhea and 53% with migratory arthralgias. Major early postoperative morbidity occurred in 11%, with no mortality. We conclude that SRVG is a safe and effective procedure to combine with JIB takedown.