Intestinal bypass, malabsorptive procedure Jejuno-ileal bypass, enteral shunt (Fig. 1)
Based on the loss of weight observed after partial small bowel removals, experimental studies on the absorption of nutrients in the small bowel and weight loss subsequent to small bowel removals were conducted in the early 50’s. Kremen, Linder and Nelson reported a jejuno-ileal bypass (JIB, disabling large areas of absorptive surfaces within the small bowel by a shunt (bypass) between the beginning and end-part of the small bowel) performed on a 34-year-old woman weighing 174 kilograms (383½ lb.). The general principle behind this (intestinal bypass, enteral shunt) developed into traditional malabsorption surgery.
Here, the largest part of the small bowel was disabled by laying a blind sling. Only a small part of the jejunum (20cm) and the ileum (20cm) are left to remain as absorptive surface. Apart from bothersome foul-smelling fatty stools, side effects were severe deficiencies, foremost amongst them protein deficiencies, disturbed salt balance, rheumatoid articular symptoms, hepatic diseases, vitamin deficiencies and kidney stone diseases. These were attributable to the so-called short bowel syndrome or to bacterial infections in the disabled small bowel sling with absorption of bacterial metabolic products into the body.
- Abb. 1: Intestinal bypass
For about 10 years, until the end of the 70s, this method found a certain degree of prevalence, while being modified by connecting the disabled small bowel sling to the gall-bladder, which reduced the chologenic diarrhoeas (biliointestinal shunt to improve entero-hepatic recycling of bile acid, which was part of the cause of these diarrhoeas). Another drawback of this method was the fact that after 5-10 years the part of the small bowel that had not been disabled became adaptive, and about 30% of all patients experienced weight-gain again. Regardless of this, the jejuno-ileal bypass, especially in its modified form, was not at all a bad technique, since 70% of all patients did not show any side effects while achieving a favourable reduction in body-weight. Currently a certain renaissance of this procedure is taking place in France and Scandinavia.