Metabolic Surgery (Type II Diabetes Surgery)
Obesity, which is one of the most common diseases today, can cause different diseases in many people. Type II diabetes is one of these diseases. Type II diabetes, which occurs due to excess weight, causes patients to use insulin regularly and continuously. In the later stages of the disease, it is possible for many different diseases to emerge.
Due to the worldwide increase in the number of patients with obesity and Type II diabetes. It is well-known that medical treatment cannot completely cure type 2 diabetes, but only aims to keep blood sugar under control. Nowadays, metabolic surgery applications in suitable patients largely completely cure type 2 diabetes. Thanks to metabolic surgery, very successful results are obtained depending on the type of surgery, also other health problems that the patient may have improved, and the need for medical treatments required for insulin control is largely eliminated.
What is Metabolic Surgery?
Metabolic surgery, popularly known as diabetes or diabetes surgery, includes operations that enable both diabetes and obesity to be controlled at the same time.
Diabetes is divided into Type I and Type II. Type II diabetes, in which insulin is produced in the body but this insulin is ineffective, is generally associated with obesity. Insulin resistance is seen in Type II diabetes, which is seen in an average of 90% of those with diabetes worldwide. In healthy people, a person feels hunger and eats with a hormone secreted from the stomach.
When the stomach wall stretches with the food he eats, the stomach stops secreting hormones as a result of the stimulation to the brain and the person begins to feel full. In the meantime, foods start to pass into the intestines and be digested and absorbed. Undigested foods cause the glp-1 hormone to be secreted from here. This hormone provides more active insulin release from the pancreas and blood sugar is controlled. This hormone provides more active insulin release from the pancreas and blood sugar is controlled. However, obese people have a larger stomach and more hunger hormone secretion. These people enlarge their portions or have to eat more often in order to be full. In addition, the intestine size and the number of villi that provide food absorption increase even more. Thus, undigested food cannot reach the last part of the small intestine and the glp-1 hormone cannot be activated, as a result, the insulin in the pancreas cannot be actively released, so blood sugar begins to rise. With the effect of insulin resistance, blood sugar increases excessively in patients. Due to this diabetes starts.
Medications, diet and appropriate exercises are generally used in the treatment of type II diabetes. However, in some cases, these treatments are not sufficient and the disease progresses, bringing along different diseases such as cardiovascular diseases, paralysis, kidney and foot disorders and vision loss. In some patients, the desired results cannot be obtained despite the intensive intake of insulin. In type II diabetes, medications and other treatments are used to control the disease, not to cure it completely. However, today, more accurate results can be obtained in the treatment of type 2 diabetes by applying metabolic surgical procedures in suitable patients. Thanks to metabolic surgery, insulin that is produced in the body but does not have an effect is used. At the same time, with the improvement of other diseases caused by diabetes, the life expectancy of the patients is prolonged and their quality of life increases.
Who Is It Appropriate For?
Metabolic surgery is not suitable for all types of diabetes. These surgeries have no effect on patients with type I diabetes. In order to benefit from metabolic surgery, the body needs to produce a small amount of insulin. In this respect, different treatment methods are used in Type I diabetes where insulin is not produced.
Type II diabetes patients, who make up the majority of diabetics, are the most suitable candidates for metabolic surgery. However, even if there is type 2 diabetes, it is necessary to measure the insulin level in the pancreas before metabolic surgery, even if the person has type 2 diabetes, since insulin production in the pancreas may have decreased in patients with diabetes over 10 years. For this, the level of the C-peptide substance, which is the insulin precursor in the pancreas, is checked with a blood test.
According to the data of the World Health Organization, approximately 90% of these patients are also overweight. Body mass index is also of great importance in patient selection. In order to benefit from metabolic surgery, the body mass index of the patients must be above 35. Patients who do not respond to medical Type II diabetes treatment and have a mass index over 30 may also undergo metabolic surgery.
How Is It Applied?
Nowadays, thanks to developing medicine, metabolic surgery operation is performed in a closed manner. Operations, which are usually performed by opening 4-6 small incisions, are performed with different methods. The common feature of all surgeries is to intervene in the stomach, reduce appetite, restrict food intake, and shortcuts that will allow food to reach the last part of the small intestine.
Sleeve Gastrectomy Surgery
Most of the stomach is removed in sleeve gastrectomy, which is one of the treatment methods for Type II diabetes and obesity. In this operation, only connection points to the esophagus and intestines are left to ensure the continuity of the stomach’s digestive system. The most important purpose of sleeve gastrectomy is to reduce the stomach volume of the patients and to ensure that they are satisfied by eating much less food, and also to reduce their appetite as the region where the hunger hormone is secreted is removed. With this method, which is widely preferred today, patients can keep their appetite under control. By controlling obesity, the damages caused by Type II diabetes are also eliminated.
SJIT (sleeve and jejunoileal transit)
This method, in addition to tube stomach surgery, is aimed to reach the last part of the small intestine without digesting some foods by establishing a transition connection between 150 cm from the beginning of the small intestine and 100. Thus, the person both loses weight and improves diabetes.
One of the most important advantages of the SJIT method is that 95% of the patients who undergo an operation do not need iron and vitamin supplements. Other advantages of this method are the vast majority of patients are as follows:
- Fast weight loss,
- Being able to survive without insulin supplements,
- The elimination of disorders such as sleep apnea, reflux and hypertension,
- Cholesterol at normal values.
Transit bipartition surgery is an operation performed in addition to sleeve gastrectomy. In this operation, it is aimed to create a connection point between the small intestine and stomach after sleeve gastrectomy. The vast majority of food consumed is absorbed in the small intestine through this new port.
One of the effective methods used to control type II diabetes is gastric bypass surgery. In this operation, changes are made in the stomach and small intestine; The bag formed in the stomach is combined with the lower part of the small intestine. The upper part of the small intestine, which is separated in the first place, is connected to the lower part again. The purpose of gastric by-pass is to reduce food consumption by reducing the size of the stomach and minimizing food absorption in the small intestine. Food consumed with this application does not go into a large part of both the stomach and the small intestine. Thanks to the rapid weight loss of the patients, improvement is also provided in Type II diabetes.
Gastric bypass is one of the methods commonly used in obesity surgery. For this reason, it is often compared with sleeve gastrectomy. The most important difference between the two methods is the volume of the stomach. While most of the stomach is removed in sleeve gastrectomy surgery, the stomach is left with the same volume in gastric bypass surgery. In addition, food absorption is reduced in gastric bypass, and vitamin and mineral supplements may be required for a long time.
The purpose of ileal interposition, which is one of the metabolic surgery methods, is to increase the hormone level by changing the places of the beginning and end parts of the small intestine. In this sense, while insulin resistance hormones in the duodenum, stomach, and pancreas decrease, insulin sensitivity hormones in the small intestine increase.
Ileal interposition surgery, which is usually applied together with sleeve gastrectomy, is considered an effective method in the treatment of Type II diabetes because it changes hormone balances.
What are the risks of metabolic surgery operations?
There are some risks seen in every operation after metabolic surgery. Bleeding risk is about 0.9%, clot problems 0.3%, stenosis problems 0.3%, probability of leakage is 1-2%, and rarely, anesthesia-related problems that may occur in every surgery and very rarely (0.2%) The death of patients is among the risks of surgery. However, depending on the type of surgery performed, there are also risks such as hernia, diarrhea, vomiting, ulcer, reflux, and intestinal obstruction in the long term. However, these risks are observed proportionally in a very small patient group. The average success rate obtained from operations is 95%.
Frequently asked Questions
Is metabolic surgery the definitive solution for Type II diabetes?
Type II diabetes patients need lifelong medication, insulin supplements, diet, and exercise. However, for many years, most patients cannot follow these rules. Continuous and regular treatment also reduces the quality of life of patients. In this sense, metabolic surgery methods, which have been highly successful, reveal different results from patient to patient. Most patients discontinue insulin supplements completely after these methods. In this sense, metabolic surgery methods provide a definitive solution for these patients. In some patient groups, postoperative drug doses should be reduced much more and medical treatment should be continued. Although treatment with medication is continued after surgical methods, possible diseases are prevented by providing weight loss, and blood sugar is kept under control.
What are the points that patients should pay attention to after metabolic surgery operations?
Although these operations give effective results in most diabetic patients, patients should also make changes in their lifestyle and eating habits to increase the success rate. In this process, which also has psychological effects, it is beneficial to get help for psychiatric disorders as well as dieticians and general surgery specialists.
Patients are fed only liquid foods 2-3 days after surgery. Patients who are discharged from the hospital within an average of 4-5 days can return to their jobs after the first week and to their daily lives after the first month if they work at a desk job. However, it is necessary to be under the control of a doctor for a period of about 2 years
Who cannot have metabolic surgery?
Some patient groups cannot benefit from metabolic surgery operations applied to patients with type II diabetes. Metabolic surgical procedures are not applied to people with a body mass index below 30, people who do not have enough insulin in the pancreas, patients with severe psychiatric disease, and organ function losses due to diabetes.