Reversal of small intestinal bypass operations and concomitant vertical banded gastroplasty: long-term outcome.

BACKGROUND: Long-term complications of jejunoileal bypass (JIB) have been reported, prompting restoration of intestinal continuity and concomitant performance of vertical banded gastroplasty (VBG) for weight control. The aim of this study was to evaluate the presentation and reversal of JIB complications, late complications, mortality, and long-term weight control in patients who have undergone JIB reversal and concomitant VBG. STUDY DESIGN: From 1981 to 1994, 37 patients were treated for complications from JIB that included diarrhea (73 percent), arthritis (46 percent), malnutrition (22 percent), urolithiasis (19 percent), electrolyte disorders (19 percent), and lack of weight loss (8 percent). Four patients required preoperative parenteral nutrition to correct protein and electrolyte imbalances. Surgical management of all 37 patients included restoration of bowel continuity and VBG during the same operative procedure. RESULTS: Postoperative complications occurred in 11 patients, including prolonged ileus in seven patients, pancreatitis in three patients, and infectious complications in two. There were no deaths. Late morbidity included staple line dehiscence in four patients, incisional hernia in three patients, and reversal of the VBG in one. All patients with diarrhea, malnutrition, electrolyte disorders, and lack of weight loss had resolution of their symptoms, while urolithiasis and arthritis resolved in 86 and 53 percent of patients, respectively. In patients available for five-year follow-up evaluation, weight changes were small, shifting from a preoperative weight of 87 +/- 19 to 90 +/- 19 kg at five years (mean +/- SD). CONCLUSIONS: Restoration of intestinal continuity combined with VBG is a safe and effective operation that will reverse most of the long-term complications of JIB and provide stable weight control for up to five years.

An experimental study to determine the effects of Dermagraft on skin graft viability in the presence of bacterial wound contamination.

Dermagrafts (Advanced Tissue Science, La Jolla, Calif.) is a possible dermal substitute currently in early stages of clinical trials. It consists of polyglycolic acid mesh impregnated with viable, human, neonatal fibroblasts. The randomized prospective study with the mouse model was undertaken to determine the effect of Dermagraft on skin graft viability in the presence of wound contamination with controlled concentrations of commonly encountered burn wound pathogens. Appropriate controlled series were run concurrently. Placement of Dermagraft, or polyglycolic acid mesh, had no significant effect on skin graft viability when compared with simple skin grafts. Controlled bacterial contamination of skin grafts with Dermagraft did not significantly change the occurrence of graft viability when compared with control groups of skin grafts with controlled bacterial contamination. These studies suggest that Dermagraft does not increase the occurrence of graft loss in the face of wound bed contamination.