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Modified jejunoileal bypass surgery with biliary diversion for morbid obesity and changes in liver histology during follow-up.

AbstractBACKGROUND 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.
AuthorsIraj Fazel, Akram Pourshams, Shahin Merat, Roya Hemayati, Masoud Sotoudeh, Reza Malekzadeh
JournalJournal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract (J Gastrointest Surg) Vol. 11 Issue 8 Pg. 1033-8 (Aug 2007) ISSN: 1091-255X [Print] United States
PMID17514410 (Publication Type: Journal Article)
Topics
  • Adolescent
  • Adult
  • Aged
  • Biliopancreatic Diversion
  • Child
  • Female
  • Follow-Up Studies
  • Humans
  • Jejunoileal Bypass (methods)
  • Liver (pathology)
  • Male
  • Middle Aged
  • Obesity, Morbid (surgery)

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