Cholesterol saturation of bile after jejunoileal bypass increases more with a 1:3 than with a 3:1 jejunoileal ratio

Previous suggested, surprisingly, that after jejunoileal bypass surgery the lithogenicity of the bile, assessed by its cholesterol saturation and rate of gallstone formation, increases more with a 1:3 than with a 3:1 jejunoileal ratio of the functioning segment. The present study re-evaluates this by examining fasting bile samples drawn from duodenum after cholecystokinin stimulation in 34 obese patients without gallstones, who either were waiting for or had had bypass surgery, with a 1:3 or 3:1 jejunoileal ratio, 3,9, or 15 months earlier. In all groups, the cholesterol content exceeded the solubilizing capacity of the bile as determined on the basis of total lipid concentration and content of phospholipid relative to bile acids. The cholesterol supersaturation increased with bypass surgery as such, increased more with a 1:3 than with a 3:1 jejunoileal ratio, decreased with time after surgery, and reached the preoperative level at 15 months. Assuming a total lipid concentration of 10 g/dl in the bile did not change this pattern. Our results indicate that during the period of weight loss after bypass surgery the lithogenicity of gallbladder bile increases more with a 1:3 than with a 3:1 jejunoileal ratio.