Complications of Small Intestinal Short-Circuiting for Obesity

Bondar, G F

doi:10.1001/archsurg.1967.01330110123016

Cited by 83 publications

(17 citation statements)

References 10 publications

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“…Theoretically, hepatotoxins other than alcohol may be produced in the excluded lopp. Dogs subjected to bypass frequently expire, whereas those undergoing intestinal resection live, and suggest that toxic factors produced in the excluded loop may cause liver injury (22). Toxic bile acids, such as lithocholate, may be produced in the blind loop and contribute to liver injury (23), although liver lithocholate levels have not correlated with progressive liver injury in patients following jejunoileal bypass (24).…”

Section: Clinical Data and Liver Morphology Following Jejunoileal Bypassmentioning

confidence: 99%

Prognostic indicators of hepatic injury following jejunoileal bypass performed for refractory obesity: A prospective study

et al. 1981

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To evaluate factors predisposing to liver injury following jejunoileal bypass, 27 patients underwent clinical evaluation and liver biopsy prior to bypass and at 3, 6, 12, 18, and 24 months and yearly thereafter. Nineteen patients developed increased fatty infiltration of the liver, 1 developed cryptogenic cirrhosis, and 7 developed steatonecrosis, central hyaline sclerosis, or cirrhosis indistinguishable from alcoholic liver disease during the period of rapid weight loss. Two of these 7 patients developed clinical liver failure; inactive cirrhosis evolved after parenteral alimentation and reanastomosis in one, and after oral nutritional supplementation in the other. Four of 5 asymptomatic patients resolved to inactive cirrhosis as weight loss diminished. Each of the 7 patients had pericentral fibrosis on pre-bypass liver biopsies, suggesting a previous hepatic injury. These patients were older (p less than 0.02) and, 3 months following bypass, had greater cumulative per cent weight loss (p less than 0.05), higher levels of serum aspartate aminotransferase (p less than 0.005), and greater 45-min bromosulfophthalein retention (p less than 0.02). Histologic evidence of pericentral fibrosis identified patients at risk to develop steatonecrosis and cirrhosis; these lesions occurred in older patients who had greater weight loss following jejunoileal bypass.

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Section: Clinical Data and Liver Morphology Following Jejunoileal Bypassmentioning

confidence: 99%

Prognostic indicators of hepatic injury following jejunoileal bypass performed for refractory obesity: A prospective study

et al. 1981

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“…Descriptions of fatty degeneration have been reported in morbidly obese patients with jejuno-ileal bypass [8,9] and in small bowel diverticulosis [10], both conditions favouring bacterial overgrowth. Wigg et al [11] and Sajjad et al [12] showed that the prevalence of SIBO assessed by (14) C-D-xylose and lactulose or glucose breath tests was higher in patients with NASH compared with control subjects.…”

Section: Introductionmentioning

confidence: 99%

High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: A Contributor to Severe Hepatic Steatosis

et al. 2008

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“…Indeed, numerous patients required reversal of their jejuno-ileal bypass to manage nutritional complications. 13,12 Owing to the documented risks of electrolyte disturbances, vitamin malabsorption, and liver and renal damage, [14][15][16] this operation has been abandoned 17 and has no role in the modern treatment of adolescent or adult obesity. A small number of adolescents have also undergone biliopancreatic diversion, during which a partial gastrectomy is performed, with bypass of a majority of the small bowel absorptive area (Figure 1).…”

Section: History Of Adolescent Bariatric Surgerymentioning

confidence: 99%

“…Pregnancy prevention and counseling Any bariatric program that includes adolescents must include counseling to prevent pregnancy in the first [12][13][14][15][16][17][18] Bariatric surgery for pediatric extreme obesity TH Inge et al months after surgery and nutritional counseling to ensure safe pregnancy outcomes as young adults. Chance of pregnancy after bariatric surgery is increased by weight loss, which improves the ovulatory dysfunction often associated with obesity, thus increasing the risk of unplanned pregnancy if contraception is not used.…”

Section: Nutritional Risks Of Weight Loss Surgerymentioning

confidence: 99%

Bariatric surgery for pediatric extreme obesity: now or later?

2006

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Obesity is a multifactorial disease of epidemic and global proportions that poses the most significant threat to the health of our younger generations. Those who are the most extremely affected bear the largest burden of health problems. In the US, extreme obesity affects approximately 9 million adults and 2 million children, and is associated with both immediate health problems and later health risk, including premature mortality. Present medical and behavioral interventions for extreme obesity in adults and children rarely result in the significant, durable weight loss necessary to improve health outcomes, prompting a search for more aggressive measures. Weight loss (bariatric) surgery has been advocated as an intervention for those with extreme obesity. In adults, bariatric surgery results in prolonged weight control and improvement in serious obesity comorbidities, namely type 2 diabetes, dyslipidemias, hypertension and obstructive sleep apnea syndrome. A surge in weight loss operations for adolescents has been observed recently, with a threefold increase in case volumes nationwide from 2000 to 2003. Current evidence suggests that after bariatric surgery, adolescents lose significant weight and serious obesity-related medical conditions and psychosocial status are improved. Thus it is reasonable to propose that bariatric surgery performed in the adolescent period may be more effective treatment for childhood-onset extreme obesity than delaying surgery for extremely obese youth until adulthood. This position has been echoed by a number of groups and an independent systematic review. Finally, it is conceivable that bariatric surgery performed in adulthood for childhood onset extreme obesity may not be as effective for comorbidity treatment as surgery performed earlier during adolescence. The purpose of this review is to examine the evidence, which supports early rather than later use of bariatric surgery in the treatment of extreme obesity, and to present this information in light of the medical and surgical risks of bariatric surgery.

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Complications of Small Intestinal Short-Circuiting for Obesity

Cited by 83 publications

References 10 publications

Prognostic indicators of hepatic injury following jejunoileal bypass performed for refractory obesity: A prospective study

Prognostic indicators of hepatic injury following jejunoileal bypass performed for refractory obesity: A prospective study

High Prevalence of Small Intestinal Bacterial Overgrowth in Patients with Morbid Obesity: A Contributor to Severe Hepatic Steatosis

Bariatric surgery for pediatric extreme obesity: now or later?

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