Jejunoileal bypass for the treatment of massive obesity. Prevalence, morbidity, and short- and long-term consequences.

The jejunoileal bypass for patients 125 lb or more above their ideal body weight as an experimental procedure exchnages almost certain weight loss for many known and many yet undescribed problems. Study of the known complications has led to altered operative procedures and management techniques that lessen the impact of nearly all of the complications. All patients need occasional advice on potential complications, and most experience episodes of depletions or diarrhea that require hospital intervention. The improved versions of this surgery have not been present sufficiently long to indicate the real nature of long term changes, and careful evaluation is essential for at least small groups of these patients in order for all interested physicians to provide proper advice to the 10,000 or so patients who have already had this procedure. Careful selection of patients to identify those who will accept follow-up and seek help when needed, and to identify those with sufficient social adaptability to adjust to a change in body image, and a competent, experienced acute and chronic team for management lead to the majority of patients having a very satisfactory result. Many specific complications of massive obesity are specifically helped by this procedure. In America, this is the only treatment effective more than half of the time in the massively obese.