Jejunostomy with port of the excluded loop in laparoscopic bilio-interstinal bypass for morbid obesity : preliminary report of a new technique

Background: intestinal bypass for morbid obesity has almost been abandoned due to its important complications, like malabsorption and bacterial overgrowth of the excluded loop. Biliointestinal bypass is still used, because it reduces bile salt malabsorption by means of an anastomosis between the gallbladder and the excluded jejunal loop. With the aim to prevent the malabsorption syndrome and the bacterial overgrowth of the excluded loop, the authors present a technical modification of the biliointestinal bypass. Methods: From 1989 to December 2003, 92 morbidly obese patients were submitted to biliointestinal bypass, 82 open and 10 laparoscopic. Mean age was 37.2 years (range 19-54), mean weight 145.7 kg (range 105-225), mean BMI 49.2 (40-66). During 2 laparoscopic operations, a jejunostomy catheter was inserted in the excluded loop, and was connected to a suprafascial port. Results: Jejunostomy with port allowed us to administer antibiotics active on the intestinal bacterial flora, as well as vitamins, oligoelements and electrolytic solutions. Catheter and port positioning did not modify the average operative time. No complications were observed. Conclusions: Jejunostomy with port of the excluded loop during biliointestinal bypass is a feasible technique even in laparoscopic operations, and allows to control both bacterial proliferation in the excluded loop and selective malabsorptions.