Various treatment methods are being developed due to the fact that the number of patients with obesity and Type II diabetes are increasing worldwide. It is known that medical treatment cannot completely cure type 2 diabetes, it is only aimed at keeping blood sugar under control. Currently, metabolic surgery practices in eligible patients largely fully treat type 2 diabetes. Depending on the type of surgery, very successful results have been obtained thanks to metabolic surgery, both other health problems of patients are corrected and the need for medical treatments necessary for insulin control is largely eliminated.

What is Metabolic Surgery?

Metabolic surgery, also popularly known as diabetes or blood sugar surgery, includes surgeries that ensure that both diabetes and obesity can be controlled at the same time.

Diabetes, also known with the name blood sugar, is divided into Type I and Type II. Type II diabetes, in which there is a production of insulin in the body, but this insulin is ineffective, is often associated with obesity. Insulin resistance is observed in Type II diabetes, which occurs on average in 90% of people with diabetes worldwide. In healthy people, with a hormone stimulated from the stomach causes a person to feel hunger and eat food. As a result of the stimulation that goes to the brain when the stomach wall is stretched by the food it eats, the stomach stops stimulating hormones and the person begins to get full. At this time, the food passes into the intestines and begins to be digested and absorbed. In healthy people, undigested foods can also easily reach the last parts of the small intestine. Undigested foods will cause the hormone glp-1 to be stimulated from here. This hormone, it allows more active insulin to be released from the pancreas and blood sugar is controlled. It is a hormone produced by the pancreas that stimulates the production of insulin in the pancreas. But obese people have a bigger stomach and more hunger hormone stimulation. These people increase their portions to get full or they have to eat more often. In addition, the number of villi that provide intestinal size and food absorption of obese people increases even more. Thus, undigested food cannot reach the last part of the small intestine and the glp-1 hormone cannot be activated, due to the fact that insulin in the pancreas cannot be activeted, blood sugar begins to rise. Blood sugar levels in these patients are extremely high due to the effect of insulin resistance.  As a result, diabetes begins.

For the treatment of type II diabetes, medications, diet and appropriate exercises are generally used too. But in some cases, these treatments are not enough, and the disease progresses, leading to various diseases such as cardiovascular diseases, stroke, kidney and foot diseases, and vision loss. In some patients, despite the intensive intake of insulin, the desired results are not achieved. In type II diabetes, medications and other treatments are used to keep the disease under control, not to completely treat it. However, today, more accurate results can be obtained in the treatment of type ll diabetes by performing metabolic surgery in appropriate patients. Thanks to metabolic surgery, the use of insulin produced in the body, but not acting, is ensured. At the same time, with the improvement of other diseases caused by diabetes, the life expectancy and quality-of-life of the patients increases.

Who Is It Suitable 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 insulin, even if in small amounts. In this sense, different treatment methods are applied in Type I diabetes where there is no insulin production.

Type II diabetics, who make up the majority of diabetics, are the most suitable candidates for metabolic surgery. But since insulin production in the pancreas may also have decreased in diabetics over 10 years of age, even if they have Type ll diabetes, it is necessary to measure the level of insulin in the pancreas, even if the person has Type ll diabetes, before metabolic surgery. For this purpose, the level of the substance C-peptide, which is the pioneer of insulin in the pancreas, is checked by a blood test.

According to World Health Organization data, about 90% of these patients are also overweight. The body mass index is also of great importance when choosing a patient. In order to benefit from metabolic surgery, patients must have a body mass index above 35. Patients who do not respond to medical Type II diabetes treatment and have a mass index above 30 may also have a metabolic surgery operation.

How is It Applied?

Today, thanks to the developing medicine, the operation of metabolic surgery is performed in a closed way. Operations that are usually performed by opening small Decisions between 4-6 are performed by different methods. A common feature of all surgeries is that they interfere with the stomach, reduce appetite, restrict food intake, and in addition, make shortcuts that will allow food to reach the last part of the small intestine

Tube Stomach Surgery

A large part of the stomach is removed in tube stomach surgery, which is one of the methods of treating type II diabetes and obesity. In this operation, only the connection points to the esophagus and intestines are left, which will ensure the continuity of the digestive system of the stomach. The most important purpose of tube stomach surgery is to reduce the volume of the patient’s stomach and ensure that they are satisfied by eating much less, as well as to reduce their appetite because the area stimulated by the hunger hormone is removed. With this method, which is widely preferred today, patients can keep their appetite under control. By controlling obesity, the damage seen due to Type II diabetes is also eliminated.

SJIT( sleeve and jejunoileal transit)

In this method, in addition to tube stomach surgery, 150 cm from the beginning of the small intestine and 100 back from the end point. By establishing a transitional link between them, it is aimed that some foods reach the last part of the small intestine being digested and stimulate the hormone Glp-1. Thus, a person loses weight and his/her diabetes improves.

One of the most important advantages of the SJIT method is that an average of 95% of patients undergoing surgery do not need iron and vitamin supplementation. Other advantages of the method in the vast majority of patients are as follows:

• Fast weight loss,
• Being able to live their lives without insulin supplementation,
• The disappearance of such illnesses as sleep apnea, reflux and hypertension to a large extent,
• Cholesterol at normal values.

Transit Bipartition

Transit bipartition surgery is an operation performed in addition to tube stomach surgery. In this operation, it is aimed to establish a connection point between the small intestine and the stomach after the tube stomach surgery. The vast majority of consumed foods are absorbed in the small intestine by passing through this new port.

Gastric By-Pass

One of the effective methods used to control Type II diabetes is gastric by-pass surgery. In this operation, changes are made to the stomach and small intestine; the bag formed in the stomach and the lower part of the small intestine are combined. The upper part of the small intestine, which was 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 stomach and minimizing food absorption in the small intestine. The food consumed with this application does not undergo a large part of both the stomach and the small intestine. Thanks to the rapid weight loss of patients, improvement is also achieved in Type II diabetes.

Gastric by-pass is also one of the commonly used methods in bariatric surgery. For this reason, it is often compared to tube stomach surgery. The most important difference between the two methods is the volume of the stomach. In gastric bypass surgery, the stomach is left with the same volume while most of the stomach is removed in tube stomach surgery. In addition, gastric bypass also reduces food absorption, and vitamin-mineral supplementation may be required for a long time.

Ileal Interposition

In ileal interposition, which is one of the metabolic surgery methods, the aim is to increase the hormone level by changing the location of the beginning and end parts of the small intestine. In this sense, the insulin resistance hormones in the duodenum, stomach and pancreas decrease, while the insulin sensitivity hormones in the small intestine increase.

Ileal interposition surgery, which is usually performed in conjunction with tube stomach surgery, is considered an effective method of treating Type II diabetes because it changes hormone balances.

What are the risks of metabolic surgery operations?

There are some risks that are seen in every operation after metabolic surgery operations. The risk of bleeding is approximately an 0.9%, clot problems of 0.3%, stenosis problems 0.3%, the possibility of leakage 1-2%, any problems with anesthesia and surgery 0.2%, are among the risks of surgery, the loss of life of the patients. However, although it varies 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. But these risks are proportionally observed in a very small group of patients. The average success rate from surgeries is 95%.

Frequently Asked Questions:

Is metabolic surgery the definitive solution for type II diabetes?

Type II diabetes patients need lifelong medication, insulin supplementation, diet, and exercise. But for many years, most patients have been unable to comply with these rules. Continuous and regular treatment also reduces the quality of life of patients. In this sense, metabolic surgery methods, which have been largely successful, produce different results from patient to patient. Most patients completely abandon insulin supplementation after these methods. In this sense, metabolic surgery methods provide a definite solution for these patients. In some patient groups, after surgery, drug doses should be reduced much more and medical treatment should be continued. Although treatment with medication is continued after surgical methods, weight loss is achieved to prevent possible diseases and keep blood sugar under control.

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