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TABLE II Complications Number of Patients Percent Diarrhea 48 98 Anorectal problems 29 59 Fissures 12 24 Bleeding, pain, etc. 17 35 Arthralgia 17 35 Kidney stones 8 16 Myasthenia-like picture 1 2 Gallstones 1 2 Persistent vomiting 1 2 Severe liver problems 1 2 Anorectal problems, especially fissures, are common complications of the diarrhea. In this series of cases, arthralgia occurred in more than a third of the patients; in one case arthritis has developed. The kidney stones which developed within seven years after the bypass operation in eight cases required surgery, in some instances. The cause of the myas-thenia-Iike picture which appeared in one patient has not been determined: these symptoms disappeared spontaneously within four weeks. Initial evaluation of the liver enzymes is observed in most patients who have any type of intestinal bypass, but these usually return to normal, or nearly so, after the weight loss has leveled off, within a year in most cases. Progressive liver disease has been reported in a few patients.The transient elevations of hepatic enzymes (SCOT and alkaline phosphatase) observed in this series — sometimes to twice normal — were more pronounced in patients who continued to drink alcoholic beverages. Therapy for hepatic dysfunction was not required by any patient who did not drink. Eight patients were unhappy with the results of the operation. In three of these, takedown of the shunt was required because of persistent vomiting, excessive weight loss or severe liver problems. Two patients did not lose enough weight. One lost no weight, had many complications, and finally went elsewhere for further surgery. The nature and results of this second procedure are not known. Two patients had satisfactory weight loss but were displeased with the procedure. One of these had severe diarrhea; the other was an unhappy woman who was probably a poor choice for the operation in the first place. DISCUSSION The effectiveness of jejunoileal bypass in accomplishing weight reduction is unquestioned. If no other surgical means of treating extreme obesity were available its use in selected cases might be justified. In 1977, however, Buckwalter" reported in this journal the results of controlled clinical trials which have demonstrated the superiority of gastric procedures over intestinal bypass operations. Last year Mason and coworkers,^" as well as Pace and associates,^' reported large series of gastric operations carried out with morbidity and mortality rates well below those usually associated with intestinal shunts. In view of these reports, 1 believe that the universal occurrence of diarrhea, the high incidence of kidney stones and arthralgia, and the occasional occurrence of arthritis following intestinal shunts are reasons enough to discontinue the use of this procedure. I concur with Ravilch and Brolin'^ in recommending that one of the gastric procedures be substituted for jejunoileal bypass when surgical treatment of morbid obesity is indicated. REFERENCES 1. Payne JH, DeWind I T: Surgical treatment of obesity. Am J Surg 118: 141. 1969. 2. Scott HW. Dean R. Shuli HJ. Ahram HS. Webb W. Younger RK, Brill AB: Considerations in use of jejunoileal bypass in patients with morbid obesity. Ann Surg 177: 723. 197^. 3. Brill AB. Sandstead HH. Price R, Johnston RE. Law DH IV. Scott HW. Jr. Changes in body composition after jejunoileal bypass in morbidly obese patients. Am J Surg 123: 49, 1972, 4. StarkloffGB. Donovan JF. Ramach KR. Wolfe BM: Metabolic intestinal surgery, its complications and management. Arch Surg 110: 652. 1975. 5. Hirsch J Jejunoileal shunt for obesity. New Engl J Med: %2. 1974. 6. Malt RA, Guggenheim FG: Surgery for obesity. N Engl J Med 295: 43, 1976. 7. Buckwalter JA: Letters to the editor. J AM A 243: 1359. 1979. 8- Buckwalter J A: Termination ofclinical trial of the surgical manauemem of morbid obesity. NC Med J 38: 460. 1977. 9. Moxley RT III, Po/,efsky T. Lockwood DH: Protein nutrition and liver disease after jejunoileal bypass for morbid obesity. N Engl J Med 290: 921. 1974. 10. Mason EE. Pnnten KJ, Barron P. I.ewis JE, Kealey GP. Blommers TJ: Reduction in gastric operations for obesity. Ann Surg 190 158. 1979. 11. Pace WG. Martin EW, Jr. Tetirick T. Fabri PJ. Carey l.C: Gastric partitioning for morbid obesity. Ann Surg 190: 392, 1979. 12. Ravitch MM. Brolin RE: The price of weight loss by jejunoileal shunt. Ann Surg 190: 382, 1979. It is probable F^hysic, as well as Religion, was in the first ages chietly traditional: every father delivering down to his sons, what he had himself in like manner received, concerning the manner of healing both outward hurts, and the diseases incident to each climate, and the medicines which were of thegreatest efficacy for the cure of each disorder. It is certain this is the method wherein the art of healing is preserved among the Americans to this day. Their diseases indeed are exceeding few: nor do they often occur by reason of their continual exercise, and (till of late) universal temperance. But if any are sick, or bit by a serpent, or torn by a wild beast, the fathers immediately tell their children what remedy to apply. And it is rare that the patient suffers long: those medicines being quick, as well as generally infallible. — John Wesley, Primitive Physic. 44() Vol. 41, No. 7
Object Description
Rating | |
Fixed Title * | NCHH-17: North Carolina Medical Journal [1940-2001] |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1980 |
Identifier | NCHH-17-041 |
Form General | Periodicals |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 41 |
Health Discipline | Medicine |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-041.pdf |
Document Sort | all; nchh-17 |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-041 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
Description
Fixed Title * | Page 442 (image) |
Document Title | North Carolina Medical Journal [1940-2001] |
Subject Topical Other | Public Health -- Periodicals.; Physicians -- North Carolina -- Directory.; Societies, Medical -- North Carolina -- Periodicals. |
Description | Includes Transactions of the Society, -1960; 1961- , Transactions issued separately, bound in.; Includes Transactions of the auxiliary to the Medical Society of the State of North Carolina and Proceedings of the North Carolina Public Health Association. Official organ of the Medical Society of the State of North Carolina, 1940-May 1972; of the North Carolina Medical Society, June 1972-. Vols. for 1940-May 1972 published by the Medical Society of the State of North Carolina; June 1972- by the North Carolina Medical Society. |
Contributor | Medical Society of the State of North Carolina. Transactions.; Medical Society of the State of North Carolina.; North Carolina Medical Society.; North Carolina Medical Society. Transactions.; North Carolina Public Health Association. Proceedings. |
Publisher | [Winston-Salem] : North Carolina Medical Society [etc.], 1940- |
Repository | University of North Carolina at Chapel Hill. Health Sciences Library. |
Host | University of North Carolina at Chapel Hill |
Date | 1980 |
Identifier | NCHH-17-041-0034 |
Form General | Periodicals |
Page Type | all; all images; chart/table; article |
Language | English |
Rights | This item is part of the North Carolina History of Health Digital Collection. Some materials in the Collection are protected by U.S. copyright law. This item is presented by the Health Sciences Library of the University of North Carolina at Chapel Hill for research and educational purposes. It may not be republished or distributed without permission of the Health Sciences Library. |
Filename | ncmed411980mediv2_0034.jp2 |
Digital Collection | North Carolina History of Health Digital Collection |
Sponsor | The North Carolina History of Health Digital Collection is an open access publishing initiative of the Health Sciences Library of the University of North Carolina at Chapel Hill. Financial support for the initiative was provided in part by a multi-year NC ECHO (Exploring Cultural Heritage Online) digitization grant, awarded by the State Library of North Carolina, and funded through the Library Services and Technology Act (LSTA). |
Volume Number | 41 |
Issue Number | 7 |
Page Number | 442 |
Health Discipline | Medicine |
Full Text | TABLE II Complications Number of Patients Percent Diarrhea 48 98 Anorectal problems 29 59 Fissures 12 24 Bleeding, pain, etc. 17 35 Arthralgia 17 35 Kidney stones 8 16 Myasthenia-like picture 1 2 Gallstones 1 2 Persistent vomiting 1 2 Severe liver problems 1 2 Anorectal problems, especially fissures, are common complications of the diarrhea. In this series of cases, arthralgia occurred in more than a third of the patients; in one case arthritis has developed. The kidney stones which developed within seven years after the bypass operation in eight cases required surgery, in some instances. The cause of the myas-thenia-Iike picture which appeared in one patient has not been determined: these symptoms disappeared spontaneously within four weeks. Initial evaluation of the liver enzymes is observed in most patients who have any type of intestinal bypass, but these usually return to normal, or nearly so, after the weight loss has leveled off, within a year in most cases. Progressive liver disease has been reported in a few patients.The transient elevations of hepatic enzymes (SCOT and alkaline phosphatase) observed in this series — sometimes to twice normal — were more pronounced in patients who continued to drink alcoholic beverages. Therapy for hepatic dysfunction was not required by any patient who did not drink. Eight patients were unhappy with the results of the operation. In three of these, takedown of the shunt was required because of persistent vomiting, excessive weight loss or severe liver problems. Two patients did not lose enough weight. One lost no weight, had many complications, and finally went elsewhere for further surgery. The nature and results of this second procedure are not known. Two patients had satisfactory weight loss but were displeased with the procedure. One of these had severe diarrhea; the other was an unhappy woman who was probably a poor choice for the operation in the first place. DISCUSSION The effectiveness of jejunoileal bypass in accomplishing weight reduction is unquestioned. If no other surgical means of treating extreme obesity were available its use in selected cases might be justified. In 1977, however, Buckwalter" reported in this journal the results of controlled clinical trials which have demonstrated the superiority of gastric procedures over intestinal bypass operations. Last year Mason and coworkers,^" as well as Pace and associates,^' reported large series of gastric operations carried out with morbidity and mortality rates well below those usually associated with intestinal shunts. In view of these reports, 1 believe that the universal occurrence of diarrhea, the high incidence of kidney stones and arthralgia, and the occasional occurrence of arthritis following intestinal shunts are reasons enough to discontinue the use of this procedure. I concur with Ravilch and Brolin'^ in recommending that one of the gastric procedures be substituted for jejunoileal bypass when surgical treatment of morbid obesity is indicated. REFERENCES 1. Payne JH, DeWind I T: Surgical treatment of obesity. Am J Surg 118: 141. 1969. 2. Scott HW. Dean R. Shuli HJ. Ahram HS. Webb W. Younger RK, Brill AB: Considerations in use of jejunoileal bypass in patients with morbid obesity. Ann Surg 177: 723. 197^. 3. Brill AB. Sandstead HH. Price R, Johnston RE. Law DH IV. Scott HW. Jr. Changes in body composition after jejunoileal bypass in morbidly obese patients. Am J Surg 123: 49, 1972, 4. StarkloffGB. Donovan JF. Ramach KR. Wolfe BM: Metabolic intestinal surgery, its complications and management. Arch Surg 110: 652. 1975. 5. Hirsch J Jejunoileal shunt for obesity. New Engl J Med: %2. 1974. 6. Malt RA, Guggenheim FG: Surgery for obesity. N Engl J Med 295: 43, 1976. 7. Buckwalter JA: Letters to the editor. J AM A 243: 1359. 1979. 8- Buckwalter J A: Termination ofclinical trial of the surgical manauemem of morbid obesity. NC Med J 38: 460. 1977. 9. Moxley RT III, Po/,efsky T. Lockwood DH: Protein nutrition and liver disease after jejunoileal bypass for morbid obesity. N Engl J Med 290: 921. 1974. 10. Mason EE. Pnnten KJ, Barron P. I.ewis JE, Kealey GP. Blommers TJ: Reduction in gastric operations for obesity. Ann Surg 190 158. 1979. 11. Pace WG. Martin EW, Jr. Tetirick T. Fabri PJ. Carey l.C: Gastric partitioning for morbid obesity. Ann Surg 190: 392, 1979. 12. Ravitch MM. Brolin RE: The price of weight loss by jejunoileal shunt. Ann Surg 190: 382, 1979. It is probable F^hysic, as well as Religion, was in the first ages chietly traditional: every father delivering down to his sons, what he had himself in like manner received, concerning the manner of healing both outward hurts, and the diseases incident to each climate, and the medicines which were of thegreatest efficacy for the cure of each disorder. It is certain this is the method wherein the art of healing is preserved among the Americans to this day. Their diseases indeed are exceeding few: nor do they often occur by reason of their continual exercise, and (till of late) universal temperance. But if any are sick, or bit by a serpent, or torn by a wild beast, the fathers immediately tell their children what remedy to apply. And it is rare that the patient suffers long: those medicines being quick, as well as generally infallible. — John Wesley, Primitive Physic. 44() Vol. 41, No. 7 |
Digital Format | JPEG 2000 |
Print / Download PDF Version | http://archives.hsl.unc.edu/nchh/nchh-17/nchh-17-041.pdf |
Document Sort | all; nchh-17 |
Article Title | Jejunoileal Bypass: An Operation Whose Time Has Passed |
Article Author | Thomas E. Simpson |
Volume Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/identi/searchterm/NCHH-17-041 |
Title Link | http://dc.lib.unc.edu/cdm/search/collection/nchh/field/documa/searchterm/NCHH-17 |
Catalog Record link | http://search.lib.unc.edu/search?R=UNCb1306322 |
Revision History | done |
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