Intestinal bypass for morbid obesity: a consecutive personal series.

Forty-five patients who underwent end-to-side jejunoileal bypass, with 51 cm in circuit, were followed up from 8 months to 8 years (average 3.4 years). There was no early or late mortality but morbidity was considerable; it included inadequate weight loss or late gain in 22%, malnutrition and liver failure in 11%, severe diarrhea and electrolyte imbalance in 11%. Cholelithiasis and wound complications also occurred. Reanastomosis was necessary in 13% (six patients). The result of the bypass was good in only 20%, satisfactory in 44% and unsatisfactory in 36%. This type of bypass is not adequate treatment for morbid obesity because the proportion of unsatisfactory results (36%) is too high and the number of good results too low and because the outcome is unpredictable. The complication of malnutrition characterized by a decline in body cell mass, an expansion of the extracellular mass and an increase in the ratio of total exchangeable sodium to total exchangeable potassium is quickly and effectively treated by intravenous administration of amino acids or protein hydrolysates. Long-term management of protein malnutrition requires a high protein diet (100 g/d) or reanastomosis.