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October 25, 1971

Intestine Bypass For Obesity

Author Affiliations

San Mateo, Calif

JAMA. 1971;218(4):598. doi:10.1001/jama.1971.03190170076034

To the Editor.—  Buchwald and Varco recommended a modified intestinal surgical bypass for the massively obese patient (217:22, 1971). They point out that the end-to-side jejunoileal shunt may lead to reflux into the bypassed ileum. This is indeed a problem. In one of my patients who failed to lose weight satisfactorily after jejunoileal shunting, end-to-side, I subsequently anastomosed the bypassed bowel into the cecum. Thereafter, the patient failed to lose more weight and a later barium study revealed that there was reflux from the cecum back up into the bypassed segment for some considerable extent (Figure).As the end-to-side jejunoileostomy appears to be efficacious in the majority of patients,1,2 it would seem preferable to use this technique in the first instance. For those patients who fail to lose weight, a second procedure disconnecting the ileum immediately proximal to the jejunoileostomy and joining it to the transverse colon may

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