The effects of reversal of jejunoileal bypass operations on hepatic triglyceride content and hepatic morphology.

Obesity is associated with significant hepatic steatosis, inflammation, and cirrhosis. These changes may be accentuated by jejunoileal bypass operations. This study is intended to determine if reconstruction of jejunoileal bypass operations alters hepatic triglyceride content and hepatic morphology. Eighty-eight +/- 27 months after jejunoileal bypass, 26 patients underwent reconstruction for a variety of complications of the operation, including five patients with cirrhosis. At the time of reconstruction, hepatic triglyceride content was 132 +/- 13 mg/100 mg protein. After reconstruction, hepatic triglyceride content increased to 205 +/- 32 mg/100 mg protein in patients whose body weight increased and decreased to 84 +/- 6 mg/100 mg protein in patients whose body weight decreased. After reconstruction, hepatic inflammation decreased in 20 patients and hepatic fibrosis decreased in 17. These changes were not related to body weight changes. In five patients with cirrhosis at the time of reconstruction, one died of liver failure and hepatic morphologic findings improved in four after reconstruction of jejunoileal bypass operations. The results of this study suggest that reconstruction of jejunoileal bypass operations with weight loss or maintenance of body weight after reconstruction is associated with decreased fat in the liver. Approximately 65% of the patients will have improvement in hepatic morphologic parameters after reconstruction. Inflammation will be more greatly benefited than will fibrosis. In some patients, hepatic histologic abnormalities are unchanged or will progress despite reconstruction of jejunoileal bypass operations.