Partial ileal bypass surgery
First introduced in 1962 by Professor Henry Buchwald of the University of Minnesota, the procedure is used to treat a number of hyperlipidemias including familial hypercholesterolemia. 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.
Ileal bypass surgery was mainly performed prior to the introduction of effective oral medication for the most common hypercholesterolemias. It is occasionally used in the surgical treatment of obesity.
As with any ileal resection, a possible complication is mild steatorrhea due to a reduced uptake of bile acids by the ileum.
- Buchwald H, Stoller DK, Campos CT, Matts JP, Varco RL (September 1990). "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. PMC 1358164. PMID 2396883. doi:10.1097/00000658-199009000-00010.
- Buchwald H (1 May 1964). "Lowering of cholesterol absorption and blood levels by ileal exclusion. Experimental basis and preliminary clinical report" (PDF). Circulation 29 (5): 713–20. PMID 14156865. doi:10.1161/01.cir.29.5.713.
- Buchwald H, Moore RB, Varco RL (October 1974). "Ten years clinical experience with partial ileal bypass in management of the hyperlipidemias". Ann. Surg. 180 (4): 384–92. PMC 1344105. PMID 4416064. doi:10.1097/00000658-197410000-00002.
- Chalstrey LJ, Winder AF, Galton DJ (November 1982). "Partial ileal bypass in treatment of familial hypercholesterolaemia". J R Soc Med 75 (11): 851–6. PMC 1438421. PMID 7143333.
- Buchwald H, Varco RL, Boen JR et al. (June 1998). "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. PMID 9625405. doi:10.1001/archinte.158.11.1253.
- Durrington P (2003). "Dyslipidaemia". Lancet 362 (9385): 717–31. PMID 12957096. doi:10.1016/S0140-6736(03)14234-1.
- Buchwald H, Avidor Y, Braunwald E et al. (October 2004). "Bariatric surgery: a systematic review and meta-analysis". JAMA 292 (14): 1724–37. PMID 15479938. doi:10.1001/jama.292.14.1724.