In view of the generally accepted fact that atherosclerosis is related to the concentration of the circulating cholesterol and equally well documented is the role of atherosclerosis in coronary heart disease, efforts to prevent, retard, arrest or reverse the atherosclerotic process have been directed towards cholesterol reduction.
There are basically three approaches to cholesterol lowering employed today; diet, drugs and surgery.
The operation of ileal bypass procedure has proved its worth in animal experimentation and successful in a limited number of human subject. The ileal bypass procedure limited not only the intestinal absorption of fat or fat soluble material but protein and carbohydrate by reduction of absorptive surface of small intestine and absorptive activity due to partial breakdown of enterohepatic circulation.
For the purpose to investigate the ideal procedure for satisfactory reduction of blood cholesterol without absorptive derangement to protein and carbohydrate, the authors made bile diversion directly into colon by "choledochoappendicostomy" and observed the post operative changes of blood cholesterol, total. protein levels and weight in rabbits and the ratio of absorption of protein and fat with ascending cholangitis in dogs.
Summary:
After the bile diversion, the contents of fat in stool were. markedly increased and the body weight was gradually diminished.
The serum cholesterol levels were also remarkablly reduced and the procedure had prevent the increase of cholesterol level even after the feeding of fatty diet.
The total serum protein levels were not significantly changed upto 6 months after the diversion in dog, but albumin levels were reduced average 27% of normal value throughout the experimental period.
The ratio of protein absorption (RISA) from intestine was also delayed and prolonged than in that of normal.
Fatty liver degeneration after the choledochoappendicostomy was developed in 33% and acute cholangitis in 25% of survival more than 3 months after operation.
But the reflux of intestinal contents into biliary tract and ascending cholangitis could avoid by segmental insertion of intestinal loop between biliary tract and colon and prevention of anastomotic stenosis.
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