Intestinal bypass. A modification

664 patients who have had metabolic intestinal surgery for the treatment of morbid obesity are reviewed. Particular attention is directed to difference in weight loss, morbidity and mortality in end-to-side and end-to-end shunts, the former performed in 300 patients and the latter in 262 patients. Unsatisfactory weight loss was observed in 20% of patients with end-to-side shunts, while only 8% of patients with end-to-end shunts failed to lose a sufficient amount of weight. Morbidity and mortality were significantly increased in this latter group. This led to adoption of a modification of the end-to-side operation by developing a plication to prevent reflux. Our preliminary observation indicates that in 102 patients who have had this operation, similar weight loss is attained to that of end-to-end shunts with no greater morbidity or mortality than the end-to-side type.