Some somatic complications after small intestinal bypass operations for obesity. Possible factors of significance in the incidence

Abstract

The complications after intestinal bypass operations in 103 massively obese subjects were recorded postoperatively for a maximum of 5 years. The surgical procedures were jejuno-ileostomy, end-to-side (op. I) in 35, and end-to-end with ileocaecostomy (op. II) in 68 cases. Wound dehiscence was the cause of the sole early postoperative death. The early complications found were those commonly seen after abdominal surgery, namely wound infection (n=24), wound dehiscence (n=5), anastomotic leak (n=2), leg thrombosis (n=2). One of the latter 2 patients probably also had pulmonary embolism. In 6 cases early intestinal obstruction occurred; 3 of them required reoperation. The late complications were divided into unspecific and specific in relation to the surgically induced malabsorption. Their incidence was analysed in 80 subjects observed for longer than 1.5 years after the operation. Unspecific late complications consisted of intestinal obstruction in 5 cases and incidional hernias in 18 cases. Intussusception was not seen. There seemed to be no increase in the incidence of gallstone disease or gastroduodenal ulcer after the operation. Specific late complications were electrolyte disturbances (ED) in 13, signs of liver injury (LI) in 9, urinary-tract calculi (UTC) in 15, and immunopathy (IM) in 19 cases. The IM group had skin rashes, arthralgia, and fever. Besides these somatic complications, a number of specific pyschictric complications were also observed (not published). Three subjects died after the operation with signs of liver insufficiency. The following factors were found to be of importance in the occurence of the specific complications ED and LI: 1. The presence of preoperative abnormalities in serum-electrolyte concentration and pathological liver tests, mainly occuring in the heavies patients. 2. Most ED and LI occurred during the period of main weight loss, in general during the first postoperative year. ED and LI did not appear after body weight had stabilised. 3. The rate of weight loss: ED and LI occurred, with a few exceptions, in the subjects with a rate of weight loss higher than 0.0130 weight-index units per week during the period of constant weight loss (see article).