February 1981

Obstruction of the Defunctionalized Small Bowel

Author Affiliations

Des Moines, Iowa

Arch Surg. 1981;116(2):253. doi:10.1001/archsurg.1981.01380140097034

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To the Editor.—The article by Aitken et al (Archives 1980;115:1031-1036) on obstruction of the defunctionalized small bowel after jejunoileal bypass is interesting, in that six of the seven cases described had a Scott-type end-to-end jejunoileal anastomosis rather than an end-to-side Payne procedure. In case 4, the obstruction was attributed to adhesions and it is not stated specifically whether an end-to-side or end-to-end anastomosis was performed.

I have had experience with almost 1,000 Payne-type jejunoileal anastomoses and I have never encountered volvulus that involves the small intestine. I also think that pneumatosis cystoides intestinalis is seldom encountered after an end-to-side procedure. The establishment of an end-to-end jejunoileostomy with implantation of the bypassed ileum into the cecum, transverse or sigmoid, undoubtedly creates more opportunities for volvulus and internal hernias than an end-to-side Payne anastomosis.

Most of the enumerated cases seem to have had satisfactory weight loss, and it is to the

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