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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
DREW EJ. Obstruction of the Defunctionalized Small Bowel. Arch Surg. 1981;116(2):253. doi:10.1001/archsurg.1981.01380140097034
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