Partial ileal bypass surgery explained

Partial ileal bypass surgery
Specialty:	gastroenterology

Partial ileal bypass surgery is a surgical procedure which involves shortening the ileum to shorten the total small intestinal length.^[1]

First introduced in 1962 by Professor Henry Buchwald of the University of Minnesota,^[2] the procedure is used to treat a number of hyperlipidemias including familial hypercholesterolemia.^{[3] [4]} The only randomized controlled trial comparing bypass surgery with standard management was the POSCH trial, which was conducted by Buchwald and his team. The trial ran between 1975 and 1983 and included 838 men who had survived a heart attack. This trial initially failed to show any benefit on mortality, but in 1998 follow-up results indicated that in addition to its known benefit on cholesterol levels and disease events it had also decreased mortality in the treatment group.^[5]

Ileal bypass surgery was mainly performed prior to the introduction of effective oral medication for the most common hypercholesterolemias.^[6] It is occasionally used in the surgical treatment of obesity.^[7]

As with any ileal resection, a possible complication is mild steatorrhea due to a reduced uptake of bile acids by the ileum.

See also

• Familial hypercholesterolemia
• Ileojejunal bypass

Notes and References

1. 10.1097/00000658-199009000-00010 . Buchwald H, Stoller DK, Campos CT, Matts JP, Varco RL . Partial ileal bypass for hypercholesterolemia. 20- to 26-year follow-up of the first 57 consecutive cases . Ann. Surg. . 212 . 3 . 318–29; discussion 329–31 . September 1990 . 2396883 . 1358164.
2. Buchwald H . Lowering of cholesterol absorption and blood levels by ileal exclusion. Experimental basis and preliminary clinical report . Circulation . 29 . 5. 713–20 . 1 May 1964. 14156865 . PDF . 10.1161/01.cir.29.5.713. free .
3. Buchwald H, Moore RB, Varco RL . Ten years clinical experience with partial ileal bypass in management of the hyperlipidemias . Ann. Surg. . 180 . 4 . 384–92 . October 1974 . 4416064 . 10.1097/00000658-197410000-00002 . 1344105.
4. Chalstrey LJ, Winder AF, Galton DJ . Partial ileal bypass in treatment of familial hypercholesterolaemia . J R Soc Med . 75 . 11 . 851–6 . November 1982 . 7143333 . 1438421.
5. Buchwald H, Varco RL, Boen JR, etal . Effective lipid modification by partial ileal bypass reduced long-term coronary heart disease mortality and morbidity: five-year posttrial follow-up report from the POSCH. Program on the Surgical Control of the Hyperlipidemias . Arch. Intern. Med. . 158 . 11 . 1253–61 . June 1998 . 9625405 . 10.1001/archinte.158.11.1253. free .
6. Durrington P . Dyslipidaemia . Lancet . 362 . 9385 . 717–31 . 2003 . 12957096 . 10.1016/S0140-6736(03)14234-1.
7. Buchwald H, Avidor Y, Braunwald E, etal . Bariatric surgery: a systematic review and meta-analysis . JAMA . 292 . 14 . 1724–37 . October 2004 . 15479938 . 10.1001/jama.292.14.1724 .