Modified Jejunoileal Bypass Surgery With Biliary Diversion for Morbid Obesity and Changes in Liver Histology During Follow-Up

J Gastrointest Surg. 2007 Aug;11(8):1033-8. doi: 10.1007/s11605-007-0184-1.

Abstract

Background and aims: Bariatric surgery is the most effective treatment for morbid obesity. The classic procedure, jejunoileal bypass, has many complications including rapid progress of liver disease. The senior author (I.F.) has developed a modification of jejunoileal bypass, which we believe overcomes many of the shortcomings of the classic procedure.

Methods: Consecutive patients referring for bariatric surgery were included. A modified jejunoileal bypass in which the defunctionalized limb is eliminated by anastomosing its ends to the gall bladder and cecum was performed. Liver biopsies were taken during operation and at a mean of 16 months later. The patients were followed for 5 years.

Results: Forty-three patients were enrolled. The mean value of weight and body mass index (BMI) fell from 128 kg and 46 kg/m(2) before operation to 85 kg and 31 kg/m(2) at 5 years, respectively (p < 0.001). There was no significant change in the degree of liver steatosis and necroinflammation. The mean liver fibrosis score increased from 0.1 to 0.9 (p = 0.015). No sign of advanced liver disease was observed during the 5-year follow-up.

Conclusion: The modified jejunoileal bypass is very effective in inducing and maintaining weight loss for 5 years and does not lead to hepatic failure or rapid progression of liver disease.

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Biliopancreatic Diversion*
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Jejunoileal Bypass / methods*
  • Liver / pathology*
  • Male
  • Middle Aged
  • Obesity, Morbid / surgery*