The incidence of cholelithiasis after jejunoileal bypass

In a prospective study of morbid obesity at the University of Florida, 225 consecutive patients with medical complication of obesity underwent intestinal bypass during a ten-year period from 1967 to 1977. The average age was 35 years, with the average weight being 322 lb (145 kg). Oral cholecystograms were obtained preoperatively in all patients, and repeated at one and five years postoperatively. If a patient developed symptoms, ultrasonography or a cholecystogram was performed at that time. The cumulative preoperative prevalence of cholelithiasis was 30.7 percent. The 156 patients with an intact gallbladder made up the study group. These patients have been followed for an average of 36 months, and 16 have subsequently demonstrated cholelithiasis. The post intestinal bypass incidence of cholelithiasis from surgery to the time of their last oral cholecystogram was 7.2 percent per year. Analysis of variance demonstrated no significant differences between patients, with and without cholelithiasis, with respect to serum triglycerides, cholesterol, or percent weight loss. The incidence of cholelithiasis in the morbidly obese increases further with the metabolic derangements induced by jejunoileal bypass. The increased incidence of cholelithiasis after intestinal bypass, along with the other serious metabolic sequelae that follow this procedure, suggests that the continued long-term followup of these patients is mandatory.