The expected benefit in this surgery: the secretion of hormones (GLP-1, Oxyntomodulin, Polypeptide YY, etc.) that will increase insulin sensitivity by passing the food directly to the last part of the small intestine, GIP, glucagon, etc. Reducing the release of certain hormones. Insulin, which is produced in the body but cannot be used sufficiently, will be used more efficiently, and there will be no need for diabetes medications and insulin injections.
Is there any metabolic surgery other than the ileal interposition procedure?
There is a wide variety of surgical techniques in diabetes and other metabolic disorders, all of which involve the stomach and small intestine.
What is Diabetes Surgery?
Diabetes is treated with diet, exercise and medication. In cases where these methods are insufficient, the damage of diabetes that starts in the body, especially in the capillaries, can progress to organ loss.
Very few of the patients pay attention to their sports and diet and use their medications regularly. The most successful and effective treatment of type 2 diabetes is metabolic surgery methods that have been developed and proven effective in the last 10 years.
Metabolic surgery, by reducing the amount of food taken and by changing the intestinal relocation or passage ways to start the nutrient absorption from the last part of the intestine so that peptides such as GLP-1 released in the intestine can be released, provide more active work of hormones to eliminate the problem of diabetes.
How is Diabetes Surgery Performed?
The decision for surgery should be made by a joint decision of the patient and the doctor, after the examination of the examinations and the relevant doctors. The patient should be informed about the vital effect of the disease and the complications that may occur due to the disease.
First, the patient undergoes a detailed examination and examination. The choice of the surgical technique to be performed on the patient is determined according to the patient’s body mass index. The patient should also be informed about the technical details. The surgeon will determine the choice of technique with information such as the patient’s body mass index, history of the disease, medications used, and previous abdominal surgeries.
Surgery is a series of operations performed in the same session under the name of metabolic surgery. In order to eliminate the disease, hormonal changes are developed in the patient by operations on the intestines and stomach. In some patients, obesity, as well as diabetes, is also eliminated with this surgery.
In the first stage of the operation, there is a section in the stomach called the fundus that produces the hunger hormone called gherline. When this part is cut and removed with a surgical procedure, the amount and desire to eat decreases; The problem of obesity ends, the weight of diabetes decreases, but it does not end. Stomach intervention alone is not enough; When the stomach operation is completed, it is necessary to add the last part of the small intestine, approximately 2 meters, to the stomach exit. It provides the secretion of a number of special hormones and peptides that are effective on sugar metabolism in the last part of the intestine, called the ileum.
After the surgery is completed, the hormone secreted from the relevant part of the small intestine, looking back, removes the pressure on the pancreas, and the rate of insulin secretion increases and the disease disappears completely.
Who Is Suitable for Diabetes Surgery?
Diabetes surgery is an operation performed to rearrange the metabolism of people whose metabolism is impaired due to the disease.
Diabetes surgery is performed on Type 2 diabetes patients whose insulin stores are not depleted. After the operations, 90% of our patients completely abandoned the drugs and insulin.
Patients with advanced and delayed tissue damage are not expected to benefit from diabetes surgery; surgery cannot be performed.
How Long Does Metabolic Surgery Take?
The surgical treatment of metabolic diseases with the methods developed in recent years is called metabolic surgery. Diabetes surgery, metabolic surgery known as diabetes surgery is also used in the treatment of other diseases such as hypertension, obesity, Type 2 diabetes and high cholesterol. When metabolic syndrome diseases are not treated or incompletely treated, they cause severe diseases and organ losses that reduce the quality of life of the person or threaten life. Success rates in metabolic surgery treatment are increasing day by day. The success of treatment is much higher especially in patients who do not have organ damage or tissue destruction and who underwent early surgery.
Metabolic surgery, many surgical techniques are used. The surgeon decides on the surgical technique according to various criteria such as the patient’s height, weight, BMI, age, duration of the disease, and previous abdominal surgeries. The main target in metabolic surgery is the secretion of substances that activate the insulin production of the pancreas by stimulating the intestines.
Metabolic surgery is performed with closed, laparoscopic method by entering through four or five 5 mm and 10 mm holes. The duration of the procedure varies according to the chosen surgical technique. Depending on the method, the operation may take 1 or 4 hours. The patient may stay in the hospital for 4 or 5 days. While some of the surgeries restrict eating, some of them are surgeries that reduce the absorption of food from the intestine.
What are the Risks of Diabetes Surgery?
As with any surgery, there are general risks in this surgery. The operation was started in 2000 and achieved 92% success.
The risk of bleeding after surgery.
We use blood thinners and anticoagulants to reduce the risks of embolism and blood clotting, which are difficult to diagnose and treat in patients. These drugs cause bleeding at the surgical sites. The reason for surgeons to use these drugs even though they are aware of the risk of bleeding is to protect their patients from the risk of embolism, which is more serious than bleeding.
Pulmonary embolism (blood clot);
Due to the slowing of blood flow, it can cause clots from the legs to the lungs. For this, the patient should be dressed in compression stockings and anticoagulant drugs such as clexan should be given.
Anastomotic leak;
Diseases such as diabetes and obesity negatively affect the wound healing process, and complications are seen at a higher rate than obese and non-diabetic patients. After the operation, there may be leaks and leaks from the intestinal connections at a rate of 1-2% due to incomplete and insufficient tissue healing. Early detection of leaks allows intervention before the development of peritonitis, which causes severe damage to the patient’s intra-abdominal organs. In recent years, increasing surgical skills and experience and developments in laparoscopic device and instrument technology have significantly reduced the possibility of gastrointestinal leakage in patients.With the right selection of the instruments and materials used in the surgery, surgical experience, skill and meticulousness, these complications are significantly reduced. In addition, the patient’s preoperative behavioral discipline makes it possible to prevent some complications. If the patient is a smoker, he should stop smoking 2 weeks before the surgery. The patient loses 5-10 kg of his weight with a diet for 2 weeks before the surgery, increases the strength of the liver, which can rupture quickly, the surgeon works more easily.
Risk of infection:
The most common type of infection after the operation is the extinction of the lung areas called atelectasis in the lung and the possibility of developing a lung infection called pneumonia. Patients should do deeper breathing exercises to prevent post-operative atelectasis.
Chronic vitamin and mineral deficiencies may develop over many years. Depending on the changes made in the intestinal locations, the problem of absorption of the nutrients taken in the future may occur. Therefore, the problem of various vitamin and mineral deficiencies and low values may arise.
Which diabetes has a cure?
The pancreas of type 1 diabetics either does not produce the insulin necessary for the patients to survive, or produces little or no insulin; The treatment of type 1 diabetes patients is organized by giving the missing insulin to the patient by external injection and regulating the nutrition. The lives of TYP1 patients become much easier with treatments based on carbon dioxide measurement, in which the amount of insulin is regulated according to the amount of carbohydrates in the foods.
In type 2 diabetes patients, insulin secretion in the body and its use by cells are deficient. Providing nutritional regimes for treatment, using drugs that increase the sensitivity of cells to insulin hormone and increase insulin secretion, and providing insulin to the patient from outside in case these drugs are insufficient.
If diabetics do not pay enough attention to their treatment, if they do not comply with the necessary treatment, high blood sugar leads to additional diseases that can lead to organ loss after a while, neuropathy (damage to the nerves), nephropathy (damage to the kidneys) and retinopathy (damage to the base of the eye), occlusion of the vessels in the organs and the heart. It also causes many diseases such as capillary diseases.
What Should Those Who Have Type 2 Diabetes Surgery Pay Attention To?
Weight loss is expected in patients after type 2 diabetes surgery. This is a healthy development. Things to pay attention;
. After the 1st day after the operation, our patients can start to drink water; On the 2nd and 3rd day, liquid foods such as soup and compote are added to the diet. In general, if there is no problem, the patient can be discharged on the 3rd or 4th day.
. You should not lift heavy things for the first 20 days after the operation, and care should be taken not to get a blow to the abdomen.
. After the surgery, the patient can travel from the 10th day. . The 7th day after the operation is suitable for taking a bath.
. From the first day after the surgery, short walks should be taken in the hospital to regulate blood circulation and reduce the risk of clots and embolisms. It is important to be active and not to stay still for a long time in order to improve circulation, prevent intravascular coagulation and embolism.
. Breathing exercises are vital to ensure deep breathing from the first hours after surgery; Respiratory gymnastics should not be neglected in order to avoid complications such as sputum-related obstructions in the lungs, atelectasis, which causes pneumonia in a part of the lung and causes pneumonia.
.The most important condition to be considered is the provision of weight control. Although 90% full treatment success has been achieved in the surgeries, we expect diabetes again in some of our patients due to the diminishing and aging tissues in the following years. For now, there is statistical information about the 15-year results of patients who have undergone metabolic surgery in the world. Approximately 15-20% of the patients who recovered in a 10-year period needed to use the drug again as Type 2 diabetes.
.A time of 1-3 months is needed to fully provide sugar control after the operation.
Can all diabetic patients have “Metabolic Surgery”?
No, there are two types of diabetes, Type 1 and Type 2. Type 1 Diabetes is when the body does not produce any insulin. Type 2 Diabetes is caused by the inability to use insulin produced in the body in target cells. Metabolic Surgery methods are only applied to Type 2 Diabetes patients.
Do I have to be overweight to have metabolic surgery?
Obesity surgeries have some benefit in sugar control; Obesity surgeries are not “sugar surgery”. However, the fact that bariatric surgery is performed in a shorter time is incorrectly defined as “sugar surgery” due to its partial benefit in controlling sugar. In metabolic surgery, it is aimed to complete diabetes mellitus. The procedure is not bariatric surgery, but metabolic surgery. Regardless of the weight of the patients, the decision for surgery is made by looking at the insulin reserve. Producing enough insulin in the body is essential for surgery. Excess weight determines only the technical choice of surgery.
What does insulin depot mean?
It is the capacity and amount of the body to produce insulin in the state of hunger and satiety. According to the insulin and c-peptide values in the fasting and satiety blood of our patient, we understand whether the insulin is sufficient or not, and we decide on the type of surgery.
Are diabetes surgery and metabolic surgery the same operations?
Metabolic surgery is a definition made to categorize all surgeries performed not only for Type 2 diabetes patients but also for different metabolic diseases. Today, surgical operations performed on Type 2 diabetes patients by the public are called sugar surgery.
Can I have surgery if the test results are suitable?
Eligibility for surgery is not given only with the adequacy of insulin storage. In addition, we receive opinions and evaluations from different branch doctors such as surgeons, cardiologists, endocrinologists and anesthesiologists, pulmonologists. If there is no obstacle to the operation, you can have the operation immediately.
What is metabolic syndrome?
Metabolic syndrome is the coexistence of diseases such as hypertension, cholesterol, insulin resistance, type 2 diabetes, sleep apnea, non-alcoholic fatty liver disease and gout, which develop due to obesity.
Do I need to take vitamins for life after the surgery? In this surgical technique, the intestine is not shortened and absorption is not affected. However, due to the partially shrinking stomach capacity, there may be a deficiency in the intake of vitamins and minerals to meet the adequate need. Control examinations are recommended, necessary. However, serious vitamin and mineral deficiency is not expected as much as gastric bypass surgeries. There is no procedure to reduce absorption with surgery. We recommend our patients to take vitamins and minerals for the first 3 months. After three months, the vitamins and minerals in the foods they take are sufficient for the patients.
What should physical activity be like after surgery? In the first month after the surgery, we recommend our patients only for sports-oriented walks, which they adjust their tempo according to themselves. After the first month, our patients can swim, ride a bike, and exercise in a way that does not force their abdominal region too much. After the third month, our patients can start heavy exercises gradually.
How should water consumption be after surgery? We would like you to start drinking sips of water even on the day of your surgery. Water makes up ¾ of our body and is indispensable for life. After our surgeries, we want you to drink at least 1.5 liters of water a day until the 1st month, increasing it day by day in order to support the recovery of the body and to continue the vital activities in a healthy way. Afterwards, it should be the goal of our patients to drink 2-2.5 liters of water, exceeding this figure.
