Cirrhosis after JIB

 Q: 45 years old male status post Jejunoileal bypass (JIB) 13 years ago for obesity is now admitted for a possible liver transplant. Reversal of the jejunoileal bypass should be performed? (select one) 

 A) prior to transplant 

B) with the transplant 

C) should not be performed 

Answer: B 

JIB is an effective procedure with an intent to create therapeutic short bowel syndrome, but now rarely get performed due to its various complications including cirrhosis, electrolyte imbalance, and kidney failure. A surgeon may still consider it in patients with high morbid obesity. Cirrhosis can occur in up to 30-40 percent of the patients over the course of years. The treatment is a liver transplant. 

Most of these patients require reversal of the jejunoileal bypass. Reversal of bypass prior to transplant carries the risk of further hepatic decompensation (choice A). It can be either performed with the transplant or in some cases after the transplant in patients who develop a progressive liver injury.

#hepatology

#transplant

#surgical-critical-care

References:

1. Hocking MP, Davis GL, Franzini DA, Woodward ER. Long-term consequences after jejunoileal bypass for morbid obesity. Dig Dis Sci 1998; 43:2493. 

2. D'Souza-Gburek SM, Batts KP, Nikias GA, et al. Liver transplantation for jejunoileal bypass-associated cirrhosis: allograft histology in the setting of an intact bypassed limb. Liver Transpl Surg 1997; 3:23. 

3. Markowitz JS, Seu P, Goss JA, et al. Liver transplantation for decompensated cirrhosis after jejunoileal bypass: a strategy for management. Transplantation 1998; 65:570. 

4. Lowell JA, Shenoy S, Ghalib R, et al. Liver transplantation after jejunoileal bypass for morbid obesity. J Am Coll Surg 1997; 185:123.