Reversal of small intestinal bypass operations and concomitant vertical banded gastroplasty: long-term outcome.

BACKGROUND

Long-term complications of jejunoileal bypass (JIB) have been reported, prompting restoration of intestinal continuity and concomitant performance of vertical banded gastroplasty (VBG) for weight control. The aim of this study was to evaluate the presentation and reversal of JIB complications, late complications, mortality, and long-term weight control in patients who have undergone JIB reversal and concomitant VBG.

METHODS

From 1981 to 1994, 37 patients were treated for complications from JIB that included diarrhea (73 percent), arthritis (46 percent), malnutrition (22 percent), urolithiasis (19 percent), electrolyte disorders (19 percent), and lack of weight loss (8 percent). Four patients required preoperative parenteral nutrition to correct protein and electrolyte imbalances. Surgical management of all 37 patients included restoration of bowel continuity and VBG during the same operative procedure.

RESULTS

Postoperative complications occurred in 11 patients, including prolonged ileus in seven patients, pancreatitis in three patients, and infectious complications in two. There were no deaths. Late morbidity included staple line dehiscence in four patients, incisional hernia in three patients, and reversal of the VBG in one. All patients with diarrhea, malnutrition, electrolyte disorders, and lack of weight loss had resolution of their symptoms, while urolithiasis and arthritis resolved in 86 and 53 percent of patients, respectively. In patients available for five-year follow-up evaluation, weight changes were small, shifting from a preoperative weight of 87 +/- 19 to 90 +/- 19 kg at five years (mean +/- SD).

CONCLUSIONS

Restoration of intestinal continuity combined with VBG is a safe and effective operation that will reverse most of the long-term complications of JIB and provide stable weight control for up to five years.