Contrary to popular opinion, surgery for obesity has been performed for decades.

The jejunoileal bypass (JIB) was one of the first operations for the treatment of morbid obesity. These operations had their beginnings at the University of Minnesota in the 1950s. In this procedure, the stomach was left intact, but the intestinal flow was diverted past most of the small intestines. As such, it was a prototypical “malabsorptive” procedure.

Although effective in producing weight loss, JIB led to more complications than expected. Since the small intestine is where most of the body’s nutrients are absorbed, and was no longer accessible, patients experienced diarrhea, osteoporosis, kidney stones, and night blindness all of which were related to vitamin deficiencies. An overwhelming growth of bacteria also developed in the bypassed intestines. This led to the most disturbing complications of arthritis, an assortment of skin problems, and liver failure. Some of these patients required reoperation to reverse the JIB, whereas others had progressive liver failure and required liver transplantation. Currently, the JIB is not routinely performed and is not a recommended weight loss procedure. However, it does serve as a historical lesson that the consequences of bariatric surgery may be significant. Both patients and their doctors need to maintain a close relationship during the post-operative period to ensure that problems can be prevented or quickly addressed.

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