Liver injury following jejunoileal bypass. Are there markers?

Ninety-five of 105 patients who underwent jejunoileal bypass had preoperative and at least one set of postoperative liver tests and liver biopsy within 18 months of surgery. There were numerous and, at times, impressive histologic or biochemical abnormalities in obese patients who were not operated. No correlation was found between postoperative liver injury and the preoperative concentration of serum albumin or SGOT, or with the certain histologic lesions (steatosis, lobular necrosis or inflammation). However, the preoperative pericellular fibrosis persisted or progressed in eight of 11 of the patients. The rate of postoperative weight loss did not seem to influence liver morphology but the initial velocity of weight loss could not be determined in this study. Liver biopsy specimens demonstrated a trend for greater postoperative decreases of serum albumin concentrations (p less than 0.05) in those patients who developed more severe lesions. This study failed to demonstrate the presence of preoperative histologic or biochemical markers that could reliably predict the development of liver injury following jejunoileal bypass. The only exception was pericellular fibrosis, which was found in the preoperative liver biopsy specimens. Pericellular fibrosis is probably a risk factor for lobular fibrosis after jejunoileal bypass surgery in obese patients.