Biliointestinal Bypass Research Articles

Lipoprotein A levels after intestinal bypass operation for morbid obesity.

Serum Lipoprotein A [Lp(a)] is considered an independent risk factor for cardiovascular disease. Reduction of other risk factors such as serum triglycerides and serum cholesterol is seen after weight reduction but it has been difficult to demonstrate a similar reduction of Lp(a). In this study Lp(a) is studied following weight reduction after intestinal bypass surgery for obesity. A cross-sectional study was performed in which Lp(a) levels were compared between patients operated with intestinal bypass surgery for obesity (bilio-intestinal bypass) and a closely matched control group. The controls were chosen so as to correspond to the operated patients' preoperative body mass indices. The operated group had reduced their body mass index from a mean of 42 kg/m2 to a mean of 29 kg/m2 and had a significantly lower mean serum Lp(a) level (113 mg/l, SEM 34) than controls (207 mg/l, SEM 37), p < 0.05. Lowered Lp(a) levels are correlated to substantial weight loss following intestinal bypass surgery for obesity.

Does Bilio-intestinal Bypass Still Have a Role in the Treatment of Super-obesity?

BACKGROUND: Super-obesity (BMI > 50) is life-threatening. The jejunoileal bypass had Potential long-term problems, and weight loss with gastroplasty May be inadequate. METHODS: From 1988 to 1995, 19 Patients with morbid obesity had jejunolleal bypass with anastomosis of the fundus of the gallbladder to the proximal end of the bypassed jejunum. Of these patients, 11 were superobese, with ages 19-49 years, weight 125-172 kg, mean excess weight 97 kg (73-119) and BMI 56 (50-67). RESULTS: Mean weight loss at 3 years was 60 kg. There was no mortality and no major complications. Patients had 5-6 stools per day and some flatulence. There have been no hepatic, renal, calcium or electrolyte problems. Diseases secondary to obesity resolved. CONCLUSION: Billo-intestinal bypass has been effective and safe thus far.

Operations that are Questionable for Control of Obesity.

At the last review of the literature, there were 43 different operations or modifications thereof used for the control of obesity. An effective operation for obesity control should produce a significant weight loss (>/= 25% excess weight loss) to ameliorate the associated medico-sociopsycho-economic ramifications of the obesity. The operative and postoperative significant morbidity should be less than 20% and mortality less than 1%. The weight lost should be maintained for a long period (>/= 5 years). The effects of the operation should be reproducible and documentable by more than two authors working independently. For the purpose of this paper, operations which do not meet these criteria are considered questionable and not recommended for general use. Based on these criteria, questionable operations for treatment of obesity include: tooth wiring, acupuncture, hypothalamic center manipulation, liposuction, balloon insertion, unbanded gastric partitioning, vagotomy, gastrogastrostomy, horizontal gastroplasty, gastric wrap, gastroclip, and any variety of gastroplasty without a reinforced stoma, intestinal bypass, duodenal bypass and biliointestinal bypass. Data to substantiate this classification will be presented and discussed. Since the surgical treatment of obesity is evolving, there is need to collect data from and make modifications to improve the effects of all operations. There is not enough data at this time to prohibit the use of any operation, but the data presented will justify limiting the use of certain operations to institutions dedicated to meticulous follow-up and research.

A survey of surgical techniques for treatment of obesity and a remark on the bilio-intestinal bypass method

Surgical treatment of morbid obesity is now a common procedure. Apart from the two now almost classical methods, jejunoileal bypass and gastric bypass, other less used methods have appeared. The reason for the diversification of the surgical armamentarium is that each method has both advantages and disadvantages and, therefore, trials are continuously made to eliminate the disadvantages. A curious situation has developed, as often happens within the medical profession, in which we do not know the real cause of the situation to be treated, but by necessity (in this case) the surgeons are forced to formulate a strategy for an urgent need. This could explain, and maybe excuse, the diversification of methods for the surgical treatment of massive obesity. It is now possible to group the various