Bypass revision in unsatisfactory weight loss after jejunoileal bypass for morbid obesity

Sixteen patients with unsatisfactory weight loss after end-to-side jejunoileal bypass were treated with either simple resection of the elongated segment of the shunt (10 patients) or resection combined with conversion to an end-to-end anastomosis (Scott) (6 patients). This led to an additional median weight loss of 13.5 kg (range, 3-25 kg) after 1 year. Scott's procedure yielded the greatest weight loss, but the price was bypass enteritis, arthritis, or electrolyte disturbances in all but one patient. Two of these patients required conversion to gastroplasty. After simple resection of the shunt less than half of the patients required electrolyte supplementation. Most of these patients, however, had unsatisfactory weight loss, which necessitated further surgery in five patients. Only 6 of the 16 patients had good results. In consequence, we have for the past 2 years used conversion to gastroplasty in patients with unsatisfactory weight loss after jejunoileal bypass.