Intestinal adaptation after jejunoileal bypass for morbid obesity: a possible explanation for inadequate weight loss.

Thirty-two patients required further abdominal operations 6-77 months after jejunoileal bypass for morbid obesity. Twenty operations were needed because of inadequate weight loss, while the remaining 12 patients had lost sufficient weight but had developed complications. In all 32 patients the lengths of functioning jejunum and ileum were measured and compared with those recorded during the original operation; elongation had occurred in 29. There was a striking difference between the median increase in jejunoileal length of 44 per cent when weight loss was inadequate and 7 per cent when weight loss was adequate (P less than 0.01). Similarly, intestinal circumference and mural thickness were greater in the first group. There appears to be a relationship between intestinal adaptation and the extent of weight loss after jejunoileal bypass.