An epilogue to jejunoileal bypass

The advantages of jejunoileal bypass performed for morbid obesity have been well reported, as have its undesirable side effects. Both early and long‐term weight reduction are generally satisfactory. Problems can arise from an increased enteric circulation of bile salts, liver dysfunction, metabolic bone disease, malnutrition and metabolic failure, diarrhea and electrolyte disturbances, enteric colonization and its consequences, and renal calculi and failure. In the author's personal series of 255 patients, 62 have required restoration of intestinal continuity, largely for the complications of bacterial colonization of the blind loop. Half the patients studied (55%) developed increasing hepatic steatosis during the first postoperative year, while 9% developed micronodular cirrhosis. Some degree of osteomalacia occurred in 35% of patients within 5 years of bypass.