Long-term outcome of reversal of small intestinal bypass operations

Article Abstract:

Between 1969 and 1980, about 25,000 people underwent surgery to bypass the small intestine (jejunoileal bypass) as a treatment for morbid obesity. Although the surgery produced the desired weight loss, it caused many complications including malabsorption, hyperoxaluria (excessive oxalate in the urine), kidney stones, arthritis, osteomalacia (softening of the bones), and cirrhosis. These patients need care for their continued metabolic problems. A study was undertaken to evaluate the metabolic effect of reconstructive operations following jejunoileal bypass. Reversal of jejunoileal bypass was performed on 43 patients, all of whom had metabolic complications from the original surgery. Sixteen patients had electrolyte abnormalities, malnutrition and diarrhea; nine patients had liver cirrhosis; nine patients had kidney stones; seven had arthritis; and one had bone abnormalities. There were 29 patients who had gastroplasty (stomach bypass) performed in addition to reversal of the jejunoileal bypass; the other 14 did not have the stomach bypass. At 73 months after surgery, patients who had undergone gastroplasty weighed significantly less than the patients who underwent only reversal surgery. All patients who had electrolyte imbalance, malnutrition and diarrhea were improved after the reversal. Kidney stones either disappeared or were significantly improved in all patients after reversal. Two patients with liver cirrhosis died; liver biopsies showed improvement in four patients; and three had no change. Arthritis improved in five of seven patients. The weight patterns were significantly better in the group of patients who had gastroplasty performed; this procedure probably will prevent recurrence of obesity and thus will achieve the goal of the original jejunoileal bypass. (Consumer Summary produced by Reliance Medical Information, Inc.)

Evaluation, Complications and side effects, Obesity, Intestine, Small, Small intestine, Jejunoileal bypass, Gastric bypass

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Role of surgical intervention in the management of intestinal metastases from malignant melanoma

Article Abstract:

Malignant melanoma is a tumor, usually of the skin, that contains melanocytes (cells that produce melanin, the body's pigment). Melanoma is the most common cause of metastatic lesions found in the intestine. These metastatic lesions may cause symptoms. A review of a data base of 6,000 melanoma patients identified 102 patients who were found to have intestinal metastasis prior to death. The average patient age at the time of diagnosis of intestinal metastasis was 49.9 years. The most common symptoms were abdominal pain (29 percent of patients), intestinal obstruction (27 percent), and bleeding (26 percent). Eighty percent of patients underwent surgery, 11 percent had endoscopy (visualization of an interior cavity of the body using an illuminated optical instrument), and 5 percent underwent percutaneous biopsy (performed through the skin). All obvious intra-abdominal tumor was removed in 36 patients, providing them with a cure. These patients survived an average of 31 months. Forty-two patients who underwent palliative surgery (performed to provide the patient with comfort); and 24 patients had either symptomatic treatment or chemotherapy. These patient groups survived an average of 9.6 months. Palliative surgery was successful in providing symptomatic relief for 92 percent of patients. These findings suggest that melanoma patients who develop intestinal symptoms should be aggressively investigated. Surgery can provide relief of symptoms. If a resectable intestinal lesion is identified and removed, the patient's survival may be significantly increased. (Consumer Summary produced by Reliance Medical Information, Inc.)

Intestines, Cancer metastasis, Melanoma, Gastrointestinal cancer, Digestive system cancer

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