Abstract
Jejuno-ileal bypass (JIB) was the first surgical technique (1954) to treat severe obesity. Due to complications (liver disease, pseudo-obstruction, malabsorption, etc) JIB was largely abandoned. A modified JIB with an internal fistula (JIB-IF) to avoid malabsorption complications was developed for treatment of Type 2 diabetes (T2D). The excluded bowel of JIB was attached via fistula to the upper jejunum, decreasing overall malabsorption, but allowing nutrients to reach the lower ileum and stimulate several gut hormones. An anterior plication close to the bypass anastomosis avoids reflux into the closed loop.
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