Abstract
Jejunoileal bypass (JIB) was a malabsorptive bariatric procedure developed in the 1950s based on pioneering work in canine models. All described variants involved anastomosis between the proximal jejunum and terminal ileum. Long-term weight loss and improvement in hyperlipidemia were found to be particularly impressive. However, it became clear by the 1980s that morbidity and mortality associated with JIB were unacceptably high. The procedure was abandoned, and many patients underwent reversal to normal intestinal continuity, or revision to other bariatric procedures. Two main mechanisms underlie the complications with JIB. Malabsorption caused excessive diarrhea, nutritional and metabolic failure, and hyperoxaluria, leading to urolithiasis. Bacterial overgrowth in the defunctioned small intestine was thought to lead to immune complex-mediated development of inflammatory arthritis, and the so-called bypass enteritis syndrome. A combination of these two mechanisms was thought to be responsible for hepatic dysfunction and failure after JIB.
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