What is Metabolic Syndrome?
The coexistence of various risk factors such as diabetes, high blood pressure, overweight and high cholesterol, which play a role in the development of cardiovascular diseases, is called metabolic syndrome. Metabolic syndrome is a cause of death that needs to be emphasized because it causes serious organ damage, job loss and significant financial losses, as well as cardiovascular diseases. In our country, the frequency of metabolic syndrome in adults aged 20 and over has been determined to be 35%.
Metabolic Syndrome Diagnostic Criteria (2005), recommended by the Turkish Endocrinology Metabolism Association, Metabolic Syndrome Working Group
At least one of the following: :
• diabetes mellitus or
• Impaired glucose tolerance or
• insulin resistance
and
At least two of the following:
• Hypertension (systolic blood pressure >130, diastolic blood pressure >85 mmHg or using antihypertensive medication)
• Dyslipidemia (triglyceride level > 150 mg/dl or HDL level < 40 mg/dl in men, < 50 mg/dl in women)
/> • Abdominal obesity (BMI > 30 kg/m2 or waist circumference: > 94 cm in men, > 80 cm in women)
Patients with three of the above findings have metabolic syndrome.
Metabolic syndrome is due to obesity. We can evaluate it as the sum of all the concomitant problems caused by type 2 diabetes. However, metabolic syndrome also includes problems that can cause obesity.
Why is the Treatment of Metabolic Syndrome Important?
Metabolic syndrome, like smoking, shortens both the quality of life and lifespan, and is one of the preventable causes of death. Therefore, it is vital to treat it.
What is the Treatment of Metabolic Syndrome?
Treatment of metabolic syndrome is diet, exercise and lifestyle changes. In cases where these are not sufficient, medication and insulin therapy come to the fore. When all options are applied for type 2 diabetic patients, the success rate is 15%. The success rate of obesity in a two-year follow-up with diet, exercise and education is 3%. As can be seen from the results, more permanent and high success rate treatment options are required for the treatment of metabolic syndrome.& nbsp;
Metabolic Surgery Surgeries
Before going into the details of metabolic surgery, it is useful to emphasize that "Metabolic surgery is different from obesity surgery".
Sleeve gastrectomy performed in obesity surgery. The basis of gastric bypass, biliopancreatic diversion and duodenal switch surgeries is based on restriction and malabsorption. A significant portion of patients who undergo surgery where restrictive procedures are at the forefront will need corrective operations in the following years. Patients who undergo surgery where malabsorption is at the forefront must take iron, calcium, vitamin and mineral supplements for life.
In metabolic surgery, the need for external supplements is eliminated within 1 year after the surgery. The most important reason for long-term weight control is the increase in appetite suppressant hormone levels originating from the last part of the small intestines.
Ileal Interposition (II)
Ileal Interposition is a surgical procedure developed for the treatment of Type 2 diabetes. Type 2 Diabetes, hypertension, hyperlipidemias (high cholesterol and triglycerides) and overweight, which are examined today under the title of Metabolic Syndrome, can be treated with ileal interposition surgery. Ileal Interposition is not an obesity surgery method, therefore obesity is not among the criteria for this surgery. Ileal Interposition does not cause absorption restriction or malabsorption. After this procedure, people can continue their lives with a free diet and without vitamin and mineral supplements within six months to a year. Most patients stop all their diabetes, blood pressure and cholesterol medications after the surgery, and the majority of them are discharged without using any of these medications. Ileal Interposition works on the principle of deactivating the hormones that cause insulin resistance and increasing the hormone levels that increase insulin sensitivity. Insulin resistance hormones such as Ghrelin, GIP and glucagon are secreted from the initial parts of the digestive system, and insulin sensitivity hormones called GLP-1 are secreted from the last part of the small intestine. In particular, GLP-1 is a hormone that increases the effect of insulin and stimulates the insulin production of the pancreas.
Small intestine in ileal interposition surgery. In addition to relocating the last part of the stomach, called the ileum, the part that secretes the ghrelin hormone is also removed from the upper left outer part of the stomach in order to create other hormonal changes that will not strengthen the effect of the surgery. The function of the ghrelin hormone is to create a feeling of hunger and increase cell insulin resistance. The main purpose of removing a part of the stomach in ileal interposition surgery is not to reduce the stomach volume. The aim is to reduce the secretion of the ghrelin hormone, which triggers the feeling of hunger, and to prevent gastric dilatation that may occur due to displacement in the intestine. Therefore, a larger stomach is left in Ileal Interposition compared to sleeve gastrectomy surgery. It is a new hormonally created regulation that allows patients to eat less. For these reasons, although ileal interposition surgery is an advanced digestive system surgery, it is exactly a 'Metabolic Surgery' procedure in terms of its mechanism of action. Each step performed in Ileal Interposition surgery has a hormonal target.
Transit Bipartition
In this surgery, in addition to the gastric sleeve surgery, this part of the small intestine is marked by counting 100 or 120 cm from the last part of the small intestine, called the ileum, which connects with the large intestine. Counting another 150 cm from this point, the small intestine is cut at a distance of 250 cm from the start, the lower end is connected to the stomach, and the upper end is connected to the previously marked 100 cm. In this way, direct food entry into the last 250 cm of the small intestine is ensured. 1/3 of the food passes through the duodenum, which is the natural way, and 2/3 passes to the last part of the small intestine, called the ileum, through the newly made connection.
In this method, there is no intestinal section that is bypassed or disabled, and the intestines are Since food passage continues everywhere, absorption problems do not occur. 95% of patients continue their lives without needing any supplements.
Additional advantages of Transit Bipartition
-Prevention of tube gastric leaks due to low intragastric pressure.
-Relieves low intragastric pressure. Preventing stomach enlargement, which can be seen in the long term after gastric sleeve surgery alone.
-All areas of the small intestines can be reached with the endoscopic method. There is ongoing food passage and absorption from the system
-Access to the duodenum and bile ducts for ERCP
-No need for vitamin, mineral iron and calcium supplements due to the protection of the stomach antrum, pylorus and duodenum.
Metabolic consequences of transit bipartition
According to the 5-year early results published in 2012, it was shown that patients lost 74% of their excess weight within a 5-year period and 86% of them had their blood sugar levels under control without medication
Who Benefits from Surgery?
Type 2 diabetic patients who cannot control their blood sugar despite making diet, exercise, lifestyle changes and using medication and insulin need surgery. However, it should not be forgotten that surgery is not the first option, but the last option.
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