Total plasma cholesterol in obesity after jejunoileal bypass with 3:1 or 1:3 jejunoileal ratio. A randomized trial.

Total plasma cholesterol (TPC) was measured repeatedly in 95 morbidly obese patients who had been randomized to non-operative management or jejunoileostomy with either a 3:1 or a 1:3 jejunoileal ratio. Initially, TPC was on average 6.4 mmol/l. and it remained stable in those not operated on. Within 1 month of surgery TPC decreased to a mean of 3.9 mmol/l, at which level it remained for the following 3 years. There was no difference in TPC between patients who had a 3:1 and those who had a 1:3 jejunoileal ratio of the functioning segment. Previous studies indicated that the increase in degradation of cholesterol to bile acids is much less in 1:3 than in 3:1 bypass. This study suggests that the changes in cholesterol metabolism after jejunoileostomy are dependent on the length of functioning jejunum and ileum in such a way that the effects of the two segments counterbalance each other.