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March 22, 1976

Renal Complications of Small-Bowel Bypass Surgery

JAMA. 1976;235(12):1261. doi:10.1001/jama.1976.03260380055032

"Gastroenterostomy—a disease!" The exclamation, attributed to a famous French surgeon earlier in the century, can be readily extrapolated to other bypass operations, be they intestinal or vascular. They too give rise to worrisome complications, some of which may not become manifest for months, even years.

Jejunoileal bypass for the treatment of intractable obesity is no exception to this vulnerability. A number of reports attest to the occurrence of short-term, as well as long-range, sequelae. The most common and troublesome sequelae are diarrhea and psychiatric disorders which in some cases are severe enough to necessitate restitution of small-bowel continuity. Other complications—electrolyte disturbances, biliary stones, fatty infiltration of the liver (p 1248)—though less manifest, can also become serious. Hepatic steatosis, for instance, has occasionally progressed to cirrhosis.1,2

A less serious complication—or so it appeared until recently—is hyperoxaluria, which occasionally causes nephrolithiasis. The increased excretion of urinary oxalate is the result of