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The use of inflatable intragastric balloons is a new non-intensive approach in the treatment of obesity when poor results are obtained by more conservative treatment. The intragastric balloons are certainly less hazardous than bariatric surgery but their long term effect on body-weight reduction it is not still proved. Several types of balloons are currently in use. The two used most widely are the Garren-Edwards Gastric Bubble and the Ballobes Balloon. The Authors report their experience with these two types of anti-obesity gastric-balloon in 60 grossly obese patients.

The authors present a case of pneumatosis cystoides intestinalis, observed by chance in a patient previously subjected to end-to-end jejunoileal bypass for severe obesity. Using their observation and the cases reported in the literature as a starting point, the authors discuss the etiopathogenetic and clinical aspects of the disease, and briefly indicate what is, at present considered the correct therapeutic approach.

In 6 of our patients operated upon for pathological obesity, complete recanalization of the jejunum closed by a mechanical suture upstreams of the jejuno-ileal latero-lateral anastomosis resulted in failure of the intestinal bypass. We have modified our technique and instead of closing the jejunum with a mechanical stapler we now divide it, then bury and attach together its two ends to avoid torsion and invagination. The operation is completed by creating an anti-reflux system at the terminal end of the excluded ileum.

Jejuno-ileal shunting was performed in 67 patients with massive obesity, last ten with a side-to-side jejuno-ileal anastomose. The technique is simple and rapid and carries little risk of sepsis. No complications were observed. This particular operation is one of several surgical treatments proposed for massive obesity and appears to be most satisfactory.

The classical indications for the surgical treatment of morbid obesity is weight of at least 50% (males) and 80% (females) over the ideal body weight, in patients between 14 and 55 years of age. These limits are now being extended both to less overweight patients and to patients over 55 years of age. Jejunoileal bypass is the treatment of choice for severely overweight patients in good general condition, allowing them to continue with their eating habits. Gastric bypass is indicated in elderly patients or in patients with previous liver diseases. It should not be performed in younger patients because of the irreversibility of the procedure. A careful postoperative long-term follow-up is necessary to prevent the complications associated with each type of operation.