J. Howard Payne

Surgical treatment of obesity

Abstract 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.

Intestinal Bypass Surgery for Morbid Obesity: Long-Term Results

Since 1962, jejunoileal bypass has been performed on 59 male and 171 female subjects, aged 18 to 55 years; these patients were followed clinically. Postoperative weight loss at two years averaged 37% in men and 35% in women. Hypokalemia (23%), hypocalcemia (22%), hypoalbuminemia (9%), metabolic acidosis (14%), elevated liver enzyme values (41%), and hyperbilirubinemia (6%), were the most commonly encountered blood chemical alterations. Complications were arthritis syndrome (men, 8%; women, 19%), urinary calculi (men, 24%; women, 10%), cholelithiasis (men, 10%; women, 9%), liver impairment (men, 2%; women, 6%), and major emotional upset (men, 8%; women, 9%). Forty-nine percent of the men and 51% of the women required rehospitalization for management of complications, surgery for hernia, anorectal disorders, nutritional support, and metabolic study. There were 19 bypass-related deaths (8%), including 10 due to liver failure. ( JAMA 236:2298-2301, 1976)

A practical, systematic laboratory approach to the study of the peripheral circulation.

Excerpt During the last decade rapid strides have been made in the medical and surgical therapy of peripheral vascular disease. It has therefore become increasingly important to obtain accurate and...

The bypass graft: Its use in arterial occlusive disease

Abstract Arteriosclerotic arterial insufficiency of the peripheral blood vessels is often due to localized obstruction with a patent arterial system above and below the obstruction. The results of twenty-three bypass grafts in fifteen patients are reported. The clinical and laboratory methods of diagnosis, management, surgical technic and follow-up are described. The principles and advantages of the end-to-side bypass graft are presented. Of the twenty-three extremities treated with the bypass graft technic using the lyophilized homograft, the initial results were excellent in seventeen, improved in two and poor in four. Two patients in the last group had their grafts revised or replaced and are now in the excellent group. Our results as of now are: nineteen excellent, two improved and two poor. No patients blood flow was impaired by the surgical procedures, although we did fail to prevent an amputation. There was one death. A longer follow-up is necessary before the ultimate fate of the grafts and the final outcome of these patients will be known. However, this study indicates that the lyophilized homograft is a suitable material for bypassing arterial obstructions. In addition, the bypass graft technic is an acceptable method for the treatment of segmental occlusion of the common iliacs, internal iliac, external iliac, common femoral and superficial femoral arteries. This technic may be employed for obstruction in the popliteal artery provided the distal arteries are patent and can maintain a good blood flow to the limb after the graft is in place. The vasographic examination, which is an integrated laboratory technic for examining the peripheral circulation, proved of value in the selection of patients for the bypass graft and for lumbar sympathectomy. Vasograms were of value also in following the progress of patients at frequent intervals without mortality, morbidity or discomfort to the patient. The vasographic examination made postoperative angiograms unnecessary.

A METHOD FOR THE STUDY OF PERIPHERAL ARTERIOSCLEROSIS

The purpose of this report is to describe a method for the study of the peripheral circulation which is useful for showing changes in the blood vessels due to arteriosclerosis. The method may be used to evaluate objectively the results of surgical or medical treatment and is applicable to the study of arteriosclerosis. The technique is suitable for studies in man or in large animals such as dogs. It is performed quickly and may be repeated at intervals without harm or discomfort. The method measures physical characteristics of the arteries which may be correlated to advantage with the blood levels of cholesterol, phospholipids or other elements possibly related to arteriosclerosis.

Scientific paperThe bypass graft: Its use in arterial occlusive disease☆

Abstract Arteriosclerotic arterial insufficiency of the peripheral blood vessels is often due to localized obstruction with a patent arterial system above and below the obstruction. The results of twenty-three bypass grafts in fifteen patients are reported. The clinical and laboratory methods of diagnosis, management, surgical technic and follow-up are described. The principles and advantages of the end-to-side bypass graft are presented. Of the twenty-three extremities treated with the bypass graft technic using the lyophilized homograft, the initial results were excellent in seventeen, improved in two and poor in four. Two patients in the last group had their grafts revised or replaced and are now in the excellent group. Our results as of now are: nineteen excellent, two improved and two poor. No patients blood flow was impaired by the surgical procedures, although we did fail to prevent an amputation. There was one death. A longer follow-up is necessary before the ultimate fate of the grafts and the final outcome of these patients will be known. However, this study indicates that the lyophilized homograft is a suitable material for bypassing arterial obstructions. In addition, the bypass graft technic is an acceptable method for the treatment of segmental occlusion of the common iliacs, internal iliac, external iliac, common femoral and superficial femoral arteries. This technic may be employed for obstruction in the popliteal artery provided the distal arteries are patent and can maintain a good blood flow to the limb after the graft is in place. The vasographic examination, which is an integrated laboratory technic for examining the peripheral circulation, proved of value in the selection of patients for the bypass graft and for lumbar sympathectomy. Vasograms were of value also in following the progress of patients at frequent intervals without mortality, morbidity or discomfort to the patient. The vasographic examination made postoperative angiograms unnecessary.

Management of acute popliteal arterial occlusion

Several objective laboratory tests have been described which assist in selecting patients with acute popliteal arterial obstruction for emergency lumbar sympathectomy. From information so obtained it is possible to locate the site of obstruction, estimate the amount of arterial insufficiency and determine the amount of collateral circulation. If it can be demonstrated that vasospasm is a major factor in the ischemia of the limb, lumbar sympathectomy should be done as an emergency procedure and not as a last resort. Limited lumbar sympathectomy (L3) as described produced satisfactory but incomplete sympathetic denervation of the toes in the patients evaluated by these procedures.