[Treatment of extreme obesity]

23 patients whose weight varied from ninety-eight to 220 kilos were subjected to four different types of jejuno-ileal by pass operations: terminal-lateral (14 X 4) in three, terminal-terminal (14 X 4) in fifteen, (12 X 8) in two, and (10 X 8) in three. The defunctionalized intestine was anastomized to the transverse colon. Liver, jejenum and ileal biopsies as well as profilactic apendectomy were performed in all the cases along with colecistectomy when possible. All our patients were carefully studied in the pre and postoperative periods. The postoperative follow-up varied from 16 to 72 months, during which time a short and long-term mortality of 8.6% was observed. In eight patients it was necessary to reestablish normal intestinal transit for one or two reasons: rapid weight loss or total lack of patient cooperation. During the first few months post-op, diarrhea, nausea, vomiting, loss of apetite, weakness, inactivity, depression, electrolyte anormalities, anemia and increased hepatic esteatosis were the clinical and pathological findings most frequently encountered. With the cooperation of the patient it is possible to correct all these alterations: it is for this reason that the importance of right patient selection is emphasized. The rate of post-operative weight loss varied from patient to patient with an ideal weight being achieved between 18 and 24 months after the operation. Only in those patients reoperated upon to establish normal intestinal transit was the lost weight recuperated. Along with rigid patient selection, the success of this operation depends upon interspecialty teamwork during the preoperative evaluation as well as the follow up period in order to resolve the intricate physio-pathological problems that so frequently arise.