Intestinal bypass. A randomized, prospective clinical study of end-to-side and end-to-end jejunoileal bypass

Of 21 patients with morbid obesity 10 were randomly allocated to ES (end-to-side) and 11 to EE (end-to-end) jejunoileal bypass. Ten patients in each group were followed up for more than 3 years. Average weight loss 18 months after operation was 37 kg or 33% of preoperative body weight in the ES group and 40 kg or 37% in the EE group (p = 0.26). One year after operation the mean serum concentration of magnesium was 0.84 mmol/l in the ES group and 0.66 in the EE group (p = 0.02), and the serum concentration of folic acid was 11.5 nmol/l in the ES group and 6.0 in the EE group (p = 0.01). The liver biopsies showed significant (p = 0.01) increased steatosis 1 year after operation in the EE group compared with peroperative biopsies, and the difference between the two groups at the 12-month follow-up almost reached statistical significance in favour of the ES group (p = 0.07). In the EE group, interposition of an intestinal segment was performed in 4 patients 17-27 months after the primary operation because of electrolyte deficiency and/or ulcer in the ileocolic anastomosis. The results in this series indicate that the ES shunt is a better operation than the EE shunt.