Gastric bypass combined with reversal of intestinal bypass for morbid obesity

Many of the estimated 100,000 patients in the United States who have had jejunoileal bypass (JIB) for morbid obesity will develop lifethreatening complications which require that the JIB be reversed. To avoid the nearly certain recurrence of morbid obesity after reversal of JIB, gastric bypass (GB) was done at the time of the reversal in 19 patients. All patients are alive and healthy. There were no immediate serious postoperative complications. The arthritis, electrolyte imbalance, and multiple gastrointestinal symptoms (bloating, diarrhea, and flatulence) caused by JIB were immediately relieved. Patient acceptance of GB has been gratifying, and most patients continue to maintain a satisfactory weight reduction. The most significant late complication has been disruption of the gastric staple line, which was diagnosed in 4 patients 2 to 21 months after operation. All 4 patients were reoperated upon because of rapid gain in weight following the disruption. The staple line disruption is probably due to repeated overeating and, therefore, overdistention of the small gastric pouch. It is safe and prudent to perform GB in most patients when the JIB must be reversed.