A Prospective Comparison of Gastric and Jejunoileal Bypass Procedures for Morbid Obesity

Abstract

A randomized prospective evaluation of the gastric and jejunoileal bypass procedures for morbid obesity was performed. The gastric bypass was performed predominantly as a 90% gastric exclusion with a Roux-en-Y reconstitution. The jejunoileal bypass was an end-to-end anastomosis between 30 cm of jejunum and 25 cm of terminal ileum, the bypassed segment of small bowel being decompressed by an end-to-side ileocolostomy. There were 32 patients in the gastric group and 27 in the jejunoileal group. The two groups were comparable in age, preoperative weight and height. There were no postoperative deaths, but the gastric bypass operation was associated with a slightly higher early complication rate indicating it is a more technically demanding procedure. Late sequellae were more prominent in the jejunoileal bypass group and included significant diarrhea in 56% and need for medication in 74%. Kidney stones and cholelithiasis also complicated the jejunoileal group and were not seen after gastric bypass. All patients showed fatty metamorphosis on the original liver biopsy. This had worsened in 75% of the jejunoileal group at one year whereas it had improved or was stable in all of the patients in the gastric group.

The effect of insulin on cardiac autonomic balance predicts weight reduction after gastric bypass

“…In particular, Roux-en-Y gastric bypass [2] has been demonstrated to yield satisfactory results both in terms of extent and long-term maintenance of weight loss [3,4]. By this technique, an average of excess weight loss (% EWL) of over 60% has been repeatedly reported (review in [5]).…”

Bariatric Surgery for Obesity: A Systematic Review and Meta-Analysis

“…Five RCTs [39][40][41][42]46 compared surgical interventions to non-surgical interventions. Four of the five were done in an adult population [40][41][42]46 and one RCT was done in an adolescent population 39 .…”

“…Four of the five were done in an adult population [40][41][42]46 and one RCT was done in an adolescent population 39 . Of the five RCTS, three compared adjustable gastric banding to conventional therapy 39,41,42 , one compared laparoscopic Roux-en-Y gastric bypass (LRYGB) with conventional therapy 40 , and the fifth RCT compared biliopancreatic diversion to diet 46 .…”

“…Adequate concealment methods were described in three studies 40,42,45 . Most other trials did not report the allocation process in sufficient details to determine concealment.…”

“…Five trials had a complete follow up in both groups 40,46,[52][53][54] , one trial 49 reported complete follow up in an earlier report but this information was not provided in the latest report.…”