Ileal bypass surgery

Packard, CJ. and Shepherd, J. 1982. The hepatobiliary axis and lipoprotein metabolism Effects of bile acid sequestrants and ileal bypass surgery. J. Lipid Res. 23, 1081-1098. 

Two studies evaluated the effects of lipid-lowering therapy on clinical endpoints in the leg. The Program on the Surgical Control of the Hyperlipidemias was a randomized trial of partial ileal-bypass surgery for the treatment of hyperlipidemia in 838 patients (9). After five years, the relative risk (RR) of an abnormal ankle-brachial index value (ABI) was 0.6 (95% Cl, 0.4 to 0.9, absolute risk reduction, 15% points, p < 0.01), and the RR of claudication or limb-threatening ischemia was 0.7 (95% Cl, 0.2 to 0.9, absolute risk reduction, 7% points, p < 0.01), as compared with the control group. 

Buchwald H, Varco RL, Marts JP, Long JM, Pitch LL, Campbell GS, et al. Effect of partial ileal bypass surgery on mortality and morbidity from coronary heart disease in patients with hypercholesterolemia. Report of the Program on the Surgical Control of Hyperlipidemias (POSCH). N Eng J Med 1990 323 946-955. 

Partial ileal bypass has been used in severe heterozygous and homozygous familial hypercholesterolemia however, it is ineffective in the latter case. Ileal bypass removes the site of bile acid reabsorption, depleting the bile acid pool and increasing the catabolism of cholesterol. A randomized trial of diet versus surgery, called Program On the Surgical Control of the Hyperlipidemias (POSCH), reported... 

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