The decline and fall of the jejunoileal bypass.

With the obvious failure of nonoperative means of producing permanent weight reduction in patients with morbid obesity, operative approaches have become popular. In the late 1960's and early 1970's, jejunoileal bypass was shown to produce permanent weight reduction and became the most performed operation. However, as the patients were observed for a long term, many untoward complications became evident. The most serious complication of liver disease and even liver failure with fatalities was observed and has accounted for 91 reported deaths following jejunoileal bypass. Other complications include severe electrolyte imbalance, requiring frequent rehospitalization of the patient; renal calculi which is related to excess oxalate absorption; arthritis which is probably secondary to complement activation of high molecular weight immune complexes formed in response to the absorption of bacterial antigens; cholelithiasis which is related to reduced bile salts; a variety of intestinal difficulties, such as bypass enteritis, and pseudo-obstruction of the colon; osteomalacia and decreased bone mineral content; failure in absorption of some medications and fat-soluble vitamins, and most recently, the possibility of induced carcinoma of the colon. Because of these many complications, it is suggested that the jejunoileal bypass is not an appropriate operation for morbidly obese patients and should be abandoned.