Unlike obesity surgeries, it is a surgical method applied to type 2 diabetes patients. Our small intestines secrete many hormones related to digestion. Hormones that increase insulin resistance are secreted from the upper parts of the small intestines and increase insulin sensitivity from the lower parts. These hormones are secreted according to the level of our food in the small intestines. However, over the last century, it has become easier for people to access food, especially in industrialized societies. At the same time, our food is more processed. As a result of processed foods, undigested food does not reach the last part of the small intestines and hormones that will increase insulin sensitivity cannot be secreted. For this reason, the rate of type 2 diabetes is increasing in societies. In these surgeries, the part of the small intestine that increases insulin sensitivity is replaced and taken to the upper part of the small intestine. As a result, it is a surgical method that takes advantage of the hormonal change that occurs as a result of relocating the small intestines. This type of surgery is called metabolic surgery.
2. To whom are these surgeries performed?
There are two types of diabetes. Type I diabetes, in which no insulin is secreted in the body, and type II diabetes, where insulin is secreted but the body cannot use it. In type 2 diabetes, insulin is secreted even more than normal, but this insulin cannot affect the cells and sugar cannot enter the cells. Thus, blood sugar remains high. Sugar control is not regular in 80% of type II patients. Metabolic surgery is applied to type II patients who secrete insulin but cannot use it. People who will benefit from surgery are type II diabetics who have full insulin stores in their body and good insulin activity. Of course, this surgery should not be performed on every type II diabetic. This surgery is only performed on patients with diabetes that cannot be controlled with medications, diet and exercise, or type II diabetics who have developed diabetes-related complications. It is already very difficult to comply with diet and exercise throughout life.
3. What are the complications of diabetes?
Diabetes is a disease whose prevalence is increasing all over the world. Parallel to the increase in the consumption of ready-made foods, which we call fast food, processed foods and foods containing preservatives, all over the world The rate of type II diabetes is also increasing. Over time, these patients will develop serious cardiovascular diseases. This can happen in the vessels leading to the heart and brain, as well as in smaller vessels. For this reason, over time, these people will begin to experience kidney failure due to kidney damage, neuropathies due to nerve damage, hearing defects in the hands and feet, and vision disorders due to eye damage.
Some of these patients will also lose weight due to the insulin administered externally by physicians. are patients who receive it. Insulin is an anabolic hormone. Externally administered insulin, in addition to the hormone they already have, causes these patients to gain weight. Due to this excess weight, complication rates will increase or there will be additional complications such as sleep apnea and breathing problems.
It should not be forgotten that some types of cancer are also common in patients with diabetes and overweight
4. What kind of preparation is made for these surgeries?
First of all, a detailed general check-up of the patients is performed. Attempts are made to detect damage to the body due to diabetes or other concomitant diseases. The cardiovascular system, kidneys, eyes and nervous system are examined. Thus, the risks of the surgery and how effective it may be in organ damage are calculated. Then, the status of the pancreas' insulin stores, insulin activity and insulin resistance rates are examined. During this examination, their sugar levels are tried to be taken under control and any other disorders are tried to be made suitable for surgery. All of these preparations are completed within 2-3 days.
6. How is life after surgery?
Patients start eating liquid foods on the 2nd or 3rd day. They are discharged on the 4th or 5th day. After 2-3 weeks of liquid foods, they switch to soft and then solid foods. Since we remove a large part of the stomach, they feel full with little food at first. At the end of 1 year, they can eat normal amounts of food. They come to the hospital periodically for control by a dietitian and endocrinologist. They are advised to stop smoking and have extremely limited alcohol intake. Vitamin supplements may be needed for the first 3 - 4 months. However, especially milk and dairy products and protein-rich foods It is recommended to feed them occasionally. As a result of the surgical technique, the patient may experience severe diarrhea after excessively fatty and high-calorie meals. For this reason, it is recommended to strongly avoid dense and fatty meals.
7. What are the complications of this surgery?
The most important complications are the openings and bleeding that may occur in the stitches. Although they are very rare, they are serious complications. In this case, re-interventions and even re-surgeries may be necessary. These surgeries are performed by the closed method we call laparoscopic. After these complications, surgery may be required or new surgeries may be required. If the diet is not followed during these surgeries, severe diarrhea will occur. However, unlike obesity surgeries, long-term vitamin deficiencies and metabolic problems are not observed in this surgery.
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