Long-term results of jejunoileostomy for extreme obesity.

The results of jejunoileostomy performed on 130 extremely obese patients in 1972-1982 are presented. The mean preoperative body weight was 130.9 kg. The postoperative observation period was 2-10 years and in 85 cases it was more than 5 years. The Salmon-Scott technique of jejunoileostomy was used in 6 cases and the Payne-De Wind method in 124. Overweight was reduced from 118% to 30.4% of normal body weight (Broca Index). Weight reduction was classified as very good or good in 82% of the patients. It was accompanied by increased psychosocial activity and improved working capacity. Disturbed carbohydrate and lipid balances normalized and liver steatosis disappeared. The direct postoperative mortality was 3.8%, and another patient died from long-term metabolic complications. Clinical symptoms of hepatic insufficiency appeared in one patient and were successfully managed with conservative treatment. Most other metabolic disturbances were transient and without clinical manifestations. They gradually subsided as adaptation progressed in the active intestinal remnant. Follow-up studies 5 to 10 years after jejunoileostomy showed that its therapeutic effects were lasting and the patients were free from persistent metabolic disturbance. In the authors' opinion, jejunoileostomy is an effective therapeutic method, though associated with certain risks.