A bypass operation for obese hyperlipidemic patients

The careful utilization of massive intestinal bypass can be indicated in the management of certain obese hyperlipidemic patients and obese patients without hyperlipidemia. The popular end-to-side anastomosis of the proximal jejunum to the terminal ileum allows direct reflux into the bypassed loop. This, in turn, may work contrary to the aims of restricting calorie, bile acid, and cholesterol absorption. We have, therefore, started to utilize for all obesity shunt procedures an end-to-end jejunoileostomy with anastomosis of the distal end of the bypassed loop side-to-side to the cecum.