| Popis: |
The jejunoileal bypass (JIB) is a malabsorptive operation that was designed to treat morbidly obese patients. The classic procedure initially described by Payne and colleagues bypasses 90% of the small bowel by transecting the jejunum about 15 in. distal to the ligament of Treitz and performing an end-to-side anastomosis to the distal ileum. Many variations of the JIB have been described, but all have the end effect of malabsorption. This surgery was the most effective weight loss operation at that time; however, it results in a number of metabolic complications, and thus has largely been abandoned in favor of less debilitating procedures. The specific adverse events associated with the JIB procedure include electrolyte abnormalities, liver insufficiency, biliary lithiasis, nephrolithiasis, bone disease, renal insufficiency, and intestinal complications. A potential increased risk of colorectal cancer is associated with this procedure, and specific management is warranted for this special consideration. The anatomy and ramifications of this operation are critical for the current surgeon to understand in order to manage these patients who are now presenting later in life with gastrointestinal malignancies requiring operation. |
