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Changes in the lipid picture of 28 grossly obese subjects induced by jejunoileal by-pass are described. The results indicate that this operation brings about a marked reduction in total cholesterol and triglycerides, and hence a distinct regression of risk factors with regard to atherosclerosis.

In 6 of our patients operated upon for pathological obesity, complete recanalization of the jejunum closed by a mechanical suture upstreams of the jejuno-ileal latero-lateral anastomosis resulted in failure of the intestinal bypass. We have modified our technique and instead of closing the jejunum with a mechanical stapler we now divide it, then bury and attach together its two ends to avoid torsion and invagination. The operation is completed by creating an anti-reflux system at the terminal end of the excluded ileum.

Change in the lipoprotein picture of 12 grossly obese subjects induced by jejuno-ileal by-pass are described. The results indicate that this operation brings about a marked reduction in lipoprotein VLDL and LDL and an increase of HDL in all examined cases, independently from weight lessening.

The authors present a case of pneumatosis cystoides intestinalis, observed by chance in a patient previously subjected to end-to-end jejunoileal bypass for severe obesity. Using their observation and the cases reported in the literature as a starting point, the authors discuss the etiopathogenetic and clinical aspects of the disease, and briefly indicate what is, at present considered the correct therapeutic approach.

Tuberculosis of organs other than the lung may occur after an intestinal bypass operation for morbid obesity, with an incidence varying from 1% to 4%, a value rather higher than that of the general population. As its clinical symptoms (fever and chills, abundant sweating and an increase or return of weight loss) appear during the period of greatest weight loss, it is probably caused by malnutrition and malabsorption. In most cases lymphadenopathy (usually cervical) also appears. Tuberculosis occurring after bypass operation should be treated with the classic antitubercular therapy; this always results in recovery if the disease is diagnosed in time.

Jejuno-ileal shunting was performed in 67 patients with massive obesity, last ten with a side-to-side jejuno-ileal anastomose. The technique is simple and rapid and carries little risk of sepsis. No complications were observed. This particular operation is one of several surgical treatments proposed for massive obesity and appears to be most satisfactory.