Intestinal bypass surgery, particularly jejuno-ileal bypass surgery, performed for the purpose of weight reduction may cause an unexpected exacerbation of nonalcoholic steatohepatitis (NASH). Here, we report a case of NASH caused by small intestinal bacterial overgrowth, which developed after jejuno-colic bypass surgery and resolved dramatically after surgical correction.
Edema ; Fatty Liver ; Jejunoileal Bypass ; Weight Loss

PURPOSE: This study was intended to investigate the migrating motor complex (MMC) changes after ileal bypass in ex-vivo mouse models. METHODS: Partial (side-to-side) and total bypass (occlusion of proximal part of bypassed loop) were performed on ileums of female Institute of Cancer Research mice. After 2 and 4 weeks, the bypassed segments were harvested and MMCs were recorded at 4 different sites ex-vivo. Amplitude, duration, interval, direction of propagation, and the area under the curve (AUC) of MMCs were measured and compared to those of the controls. RESULTS: In control mice (n = 7), most MMCs propagated aborally (91.1%). After 2 weeks of partial bypass (n = 4), there was a significant decrease in both amplitude and AUC, and orally-propagating MMCs increased significantly (45%, P = 0.002). Bidirectional MMCs (originating in the bypassed loop and propagating in both directions) were also observed (10%). The amplitude of the MMCs remained decreased at 4 weeks after partial bypass (n = 4), and neither the AUC nor the direction of propagation showed significant changes compared to 2 weeks. Similarly, in the total bypass model, both the amplitude and AUC of the MMCs decreased significantly compared to controls. In contrast to partial bypass, 95% of the MMCs within the bypassed loop propagated aborally after 2 weeks (n = 6), which was similar to the control state. After 4 weeks (n = 5), however, MMCs either lost their temporal relationship or completely disappeared. CONCLUSION: The changes in propagation direction of the MMCs in the partially bypassed loop may contribute to stagnation of bowel contents and the development of blind loop syndrome.
Animals ; Area Under Curve ; Blind Loop Syndrome ; Female ; Humans ; Ileum ; Jejunoileal Bypass ; Mice ; Myoelectric Complex, Migrating

The esophageal jejunum anastomosis of the digestive tract reconstruction techniques in laparoscopic total gastrectomy includes two categories: circular stapler anastomosis techniques and linear stapler anastomosis techniques. Circular stapler anastomosis techniques include manual anastomosis method, purse string instrument method, Hiki improved special anvil anastomosis technique, the transorally inserted anvil(OrVil(TM)) and reverse puncture device technique. Linear stapler anastomosis techniques include side to side anastomosis technique and Overlap side to side anastomosis technique. Esophageal jejunum anastomosis technique has a wide selection of different technologies with different strengths and the corresponding limitations. This article will introduce research progress of laparoscopic total gastrectomy esophagus jejunum anastomosis from both sides of the development of anastomosis technology and the selection of anastomosis technology.
Anastomosis, Surgical ; Digestive System Surgical Procedures ; Esophagectomy ; Esophagoplasty ; Esophagus ; Gastrectomy ; Humans ; Jejunoileal Bypass ; Jejunum ; Laparoscopy ; Reconstructive Surgical Procedures ; Stomach Neoplasms

Vitamin A deficiency can occur as a result of malnutrition, malabsorption, or poor vitamin metabolism due to liver disease and night blindness might develop as the first symptom. Although there have been foreign reports about night blindness due to vitamin A deficiency which was derived from liver cirrhosis, primary biliary cirrhosis, intestinal bypass surgery or bariatric operation, it is hard to find reports about night blindness after percutaneous transhepatic biliary drainage for external bile drainage. We report a case of night blindness derived from fat-soluble vitamin A deficiency developed after long-term (18 months) external bile drainage for benign biliary stricture occurred after left hepatic lobectomy and hepaticojejunostomy due to the Klatskin tumor (IIIb). Her night blindness and low serum retinol level (0.02 mg/L) was dramatically improved after vitamin A supplementation. We recommend lipid-soluble vitamin supplementation on the case of long-term external bile drainage.
Bile* ; Constriction, Pathologic ; Drainage* ; Jejunoileal Bypass ; Klatskin's Tumor ; Liver Cirrhosis ; Liver Cirrhosis, Biliary ; Liver Diseases ; Malnutrition ; Metabolism ; Night Blindness* ; Vitamin A ; Vitamin A Deficiency ; Vitamins

OBJECTIVETo evaluate the effect of sleeve gastrectomy with ileal interposition duodenojejunal bypass operation on lipid metabolism in non-obese type 2 diabetes mellitus patients.

METHODSTwenty-nine non-obese patients with type 2 diabetes mellitus underwent sleeve gastrectomy with ileal interposition duodenojejunal bypass operation. All the patients were subjected to the measurement of total cholesterol (TC), triglycerides (TG), high density lipoprotein (HDL), low density lipoprotein (LDL), homeostatic model assessment for insulin resistance (Homa-IR), glycosylated hemoglobin (HbA1c) at postoperative 12th month.

RESULTSTwelve months after ileal interposition duodenojejunal bypass operation, the blood glucose was controlled without taking hypoglycemic drugs in 28 patients (96.5%) and HbA1c decreased from (8.4±1.3)% to (6.5±1.6)% (P<0.01). Dyslipidemia were corrected in 25 cases (86.2%). TC became normal in 84.2% (15/19), and TG became normal in 82.3% (14/17). HDL became normal in 66.6% (8/12). LDL became normal in 31.2% (5/16). TC/HDL ratio decreased from 5.6±1.2 to 2.8±1.0 (P<0.01). TG/HDL ratio decreased from 3.2±1.3 to 1.5±0.8 (all P<0.01).

CONCLUSIONSleeve gastrectomy with ileal interposition duodenojejunal bypass is an effective operation for the correction of dyslipidemia in non-obese patients with type 2 diabetes mellitus.

Adult ; Blood Glucose ; analysis ; Cholesterol ; blood ; Diabetes Mellitus, Type 2 ; metabolism ; surgery ; Dyslipidemias ; surgery ; Female ; Gastrectomy ; Glycated Hemoglobin A ; metabolism ; Humans ; Jejunoileal Bypass ; methods ; Lipid Metabolism ; Male ; Middle Aged ; Obesity ; Retrospective Studies ; Triglycerides ; blood