When we eat some food, the food is sent to our intestines for digestion. Hunger is a vitally important primitive instinct and is resolved in the intestines, not in the stomach. When the food reaches the ileum (the lower part of our small intestine), satiety signals are sent, stomach emptying slows down and a feeling of satiety occurs. Here, the feeling of fullness occurs not with the first bite, but after eating a certain amount of food. Restrictive bariatric surgeries only prevent food intake and cannot provide intestinal saturation. Mechanical restriction created by bariatric surgeries is an obstacle that makes it difficult to pass food with each spoonful of food.
However, with metabolic surgery, the ileum (lower part of the small intestine) is brought forward and the ileal peptides are activated, thus not allowing food intake. , it may be possible to achieve “functional restriction” and “metabolic saturation” that limit stocking.
*With metabolic surgery, ileum-derived appetite suppressant neuropeptide hormones become active in the early stages. If the satiety signals from the intestine come too weak or too late, then the person may consume too much food until metabolic saturation occurs.
"Functional restriction" will be achieved by bringing the ileum (the lower part of the small intestine) forward. It ensures the secretion of neuropeptides originating from the small intestine without causing serious
absorption disorders
. These peptides not only provide a feeling of satiety, but also improve insulin sensitivity, suppress the production and activity of the hormone glucagon (which raises blood sugar), and reduce endogenous glucose production and the secretion of free fatty acids. This provides improvement in type 2 diabetic patients.
While providing improvement in type 2 diabetes and metabolic syndrome components, we should also not create any vitamin and mineral deficiencies in the body.
Currently, there are two published surgical options that can provide functional restriction without causing serious malabsorption.
These are Transit Bipartition (TB) and Ileal Interposition. Both surgeries are performed laparoscopically and with ghrelin secretion. It is performed together with sleeve gastrectomy to reduce blood pressure, protect against peptic ulcers, reduce calorie intake and prevent stomach expansion. However, both techniques use different strategies.
In Transit Bipartitioma, the distal activity is improved by bringing the entire ileum to the antrum, the direction of food passage here is changed without touching the duodenal route, thus reducing the proximal activity – thus increasing the risk of malabsorption.
In IT, distal small intestine activity is maximized by moving a portion of the ileum immediately after the stomach, and proximal activity is minimized by closing the duodenum to the food inlet.
Both procedures are functional (not mechanical). ) and instead of adopting malabsorption as a useful goal, they try to avoid this situation.
In conclusion, metabolic surgery is under development and studies will pave the way for different results and developments in the next step.
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