Intestinal changes after jejuno-ileal shunt in obesity: A report of 2 cases

Abstract

Two cases of end-to-end and end-to-side jejuno-ileal bypass for the treatment of obesity are reported in which both patients underwent reoperation 17 and 23 months later respectively. Macroscopic examination and measurements of length of the various segments of the small intestine have been performed twice in each patient: at the time of the bypass and at the second surgical procedure. In one patient a histological study of both the excluded and functioning small intestine was carried out at the time of each surgical procedure. The functioning intestine had increased in size while the excluded segment had become narrowed. The height of the villi had increased slightly in the functioning ileum and more so in the functioning jejunum compared with the preoperative measurements. In contrast, the height of the villi was moderately reduced in both the bypassed jejunal and ileal segments. These findings confirm the results of experimental studies in animals.

Postoperative adaptation of the small intestine

“…The bypassed jejunoileum does not share this response unless there is reflux of luminal content into the excluded loop [64]. It generally becomes hypoplastic [65,66] or remains unaltered in structure [67,68].…”

Glucagon, Secretin and Vasoactive Intestinal Polypeptide Immunoreactivities in Rat Gut after Jejuno-Ileal Bypass and Resection

“…N-terminal-to central glucagon immunoreactivity in the functional ileum did not change substantially after operations, but was significantly lower in the non-functional than func tional ileum after bypass. Plasma levels of this immunoreactivity were higher following opera tions and highest following resection.Jejuno-ileal bypass (JIB) and resection cause extensive changes in morphology of the residual functional gut [2,9,10,13,29,33,39] and the pancreas [14]. Hormonal changes are frequently studied by measuring immunoreactivities in the peripheral circula tion [1-3, 17, 19-22, 33, 39], In this investi gation, glucagon, secretin and vasoactive in testinal polypeptide (VIP) immunoreactivities were measured in extracts of the residual rat gut following resection and of functional as well as non-functional gut following JIB.…”