Surgical treatment of obesity

Our opinion of the present state of jejunoileal shunt in the treatment of obesity may be summarized as follows: (1) A jejunoileal shunt is of distinct benefit in selected patients for whom the obese state has become a hazard to health. (2) It is not the procedure one does because an obese patient is 25 to 50 pounds overweight. (3) Inasmuch as a high degree of cooperation is essential, a relationship of mutual respect, trust, and responsibility must be present between the physician and patient. A hostile attitude on the part of the patient cannot be tolerated. (4) Although long-range benefits from the control of factors leading to aggravation of cardiovascular disorders may be expected, it may be dangerous to subject patients with well established cardiovascular disease to this procedure. (5) A jejunocolic shunt should not be used for control of obesity. (6) A jejunoileal shunt should definitely be considered as an investigative procedure, for the present, and should not be undertaken unless facilities are available to handle complications and to conduct significant research into the mechanism of obesity and its attendant complications over a long period of time.