Biliointestinal bypass.

To eliminate the blind loop in conventional jejunoileal bypass (JIB) and to maintain enteroheptic circulation of bile, thus hoping to diminish important side-effects of JIB, biliontestinal bypass was introduced in 1975, entailing anastomosis of the blind jejunal loop to a functioning gallbladder. Twenty-two patients with a mean weight of 126 kg (91-154 kg) have had primary bilio-intestinal bypass and another four secondary anastomosis of the gallbladder due to side-effects of the previous JIB. A mean weight reduction of 50 kg was achieved in the 20 patients observed for 24 months, without any serious side-effects, corresponding to a reduction of overweight from 89 per cent preoperative to 14 per cent in a subsample of seven patients followed for five years. Without affecting body weight in the four patients subjected to secondary operation, it ameliorated the side-effects of JIB during observation of more than 6 months. Follow-up with i.v. cholangiography and Tc99 HIDA scintigram conclusively revealed open anastomoses in nine of ten patients adequately judged by the scan and no evidence of gallstones on 15 cholangiograms performed so far. Renal calculi were found in three patients, mainly in the first postoperative year but urine oxalate was in the normal range after more than years of follow-up. It is concluded that jejunoileal bypass combined with cholecystojejunostomy in patients with functioning gallbladders is a safe and relatively simple method for treating morbid obesity in selected cases.