Two years of clinical experience with biliopancreatic bypass for obesity

Most complications of jejunoileal bypass for morbid obesity (1-3) may be referred to two main defects ofthe classic operation. The first defect is the mechanism of malabsorp-tion itself, based on the short bowel and on the interruption of enterohepatic bile salt cir-culation. The result is an indiscriminate mal-absorption, with loss of great amounts of bile acids into the colon and, consequently, diar-rhea, electrolyte imbalance, urinary and bili-ary calculi and, perhaps, liver injury. The second defect is the presence of a long section of excluded intestinal tract, with the risk of intussusception and the consequences of pep-tic ulcer due to gastric hypersecretion and