Various obesity surgeries have been widely performed all over the world for a long time. Some of these surgeries are aimed at restricting stomach volume (stomach tube), and some are aimed at reducing food absorption (gastric bypass). It has been noticed that in a large portion of obese diabetic patients, immediately after the surgery, their sugar levels improve and the need for insulin disappears, even before they lose weight. Thereupon, it was thought that there must be other factors that provide relief from diabetes after obesity surgery, and detailed research began to be conducted on this subject.
It has been understood that changing the location of the intestines may cause these effects. It has been understood that the food passing to the last part of the small intestine increases with obesity surgery, and the secretion of the GLP-1 hormone from the cells called L cells in this part of the small intestine increases in direct proportion to the increase in this food passing.
The increase in the GLP-1 hormone also increases. It has been found that it increases the number of beta cells that secrete insulin in the pancreas. As a result, it has been understood that it increases insulin production and strengthens the insulin response. In addition, it is thought that GLP-1 eliminates insulin resistance in the liver, muscles and fat tissue, thus patients can regulate their blood sugar and get rid of diabetes without losing weight in a short time after surgery.
Thereupon, more undigested foods from the last part of the small intestine are eliminated. Surgical models have been developed that will allow surgery to occur. These surgical methods are also called diabetes surgery.
In addition to getting rid of diabetes, it can treat many co-morbidities such as high blood pressure, heart disease, high cholesterol, dyslipidemia, fatty liver and sleep apnea, which are brought on by diabetes and obesity.
To whom is Metabolic Surgery applied?
Type 2 diabetic patients with a body mass index of 30 and above and whose insulin stores have not yet been depleted can undergo this surgery. When the decision is made for surgery, your chances of recovery with surgery are examined through some tests.
How is Metabolic Surgery (Diabetes surgery) performed? Is it possible?
This surgery can be performed laparoscopically, that is, closed, like obesity surgeries. It is performed under general anesthesia, and it is a procedure that takes approximately 2-3 hours. It can be done with tools inserted through 5 holes opened in the abdomen. In the first stage, sleeve gastrectomy surgery is performed. In the second stage, the small intestine is cut at a distance of approximately 250 cm from the junction of the small intestine and the large intestine and its lower end is connected to the stomach. The last part of the small intestine is brought closer to the stomach exit. The last part of this small intestine, called the ileum, secretes a hormone called GLP-1, which stimulates the release of insulin from the pancreatic tissue, and bringing the last part of the small intestine closer to the stomach exit increases the secretion of this hormone. 2/3 of the nutrients entering the stomach will pass through this newly constructed pathway.
The third stage is the upper end of the intestine (the part that brings bile and pancreatic secretions), the lower end of which is connected to the stomach, approximately 80-100 cm from the junction of the small intestine and the large intestine. It is connected to . GIP is released from the duodenum, called Duodenum. GIP is a hormone that increases insulin resistance. Since 2/3 of the food passes through the new connection pathway and only 1/3 of the food passes through the duodenum, GIP release decreases.
It is a surgery method that both restricts volume and prevents absorption. If everything goes well after the surgery, you can start drinking water on the first day. They start eating liquid foods on the 2nd or 3rd day. If there are no additional problems, the patient is discharged on the 3rd or 4th day.
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