A review of 20 years of jejunoileal bypass

The long-term effects of jejunoileostomy for morbid obesity were studied 15-20 years after surgery, in 60 patients.

A total of 141 patients underwent surgery during the years 1973 to 1979. Thirty-four (24%) had had bowel continuity reestablished because of side effects. Eight (5.6%) were dead, 4 (2.8%) had emigrated, and 11 (7.8%) lived in remote areas, leaving 84 patients for follow-up. Sixty of these patients agreed to participate in the study. Seventy-seven per cent of the study population were women, with a mean age of 50 years.

The average weight loss was 50.2 kg; only one patient had regained the preoperative weight. The average weight was 84.2 kg. Reported side effects were 1) gastrointestinal: diarrhoea (61.7%), bad defecation smells (60%), and meteorism (11.7%), and 2) systemic: arthralgia (18.3%) and symptomatic nephro/cholelithiasis (18.3%). Forty-two patients (70% of the participants) found the results acceptable/satisfactory. Nine patients (15%) had vitamin B12 injections regularly; another 22 (35%) were found to have a low cobalamin level, and 35 patients (58%) had reduced P-magnesium. The 25-hydroxycholecalciferol level was low in 26 patients (43%), parathyroid hormone values were increased in 18 (30%). Fifty-seven patients (95%) had a P-carotene value lower than the normal limit.

These results stress the need for continuous control and supplementary therapy.