Metabolic Surgery

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Metabolic surgery is a type of surgery that aims to treat a metabolic disease with surgical methods. Metabolic surgery, also known as diabetes or sugar surgery among the people, includes surgeries that enable both diabetes and obesity to be controlled at the same time.

Proving the positive effects of bariatric surgery on Type 2 diabetes has also led to the development of laparoscopic metabolic surgery. Laparoscopic sleeve gastrectomy, duodenoileal interposition, duodenojejunal bypass and jejunoilelal interposition, transit bipartition, loop transit bipartition (SASI) surgeries are metabolic surgeries developed in this context. The operation in question can be performed within the scope of Type 2 diabetes treatment of patients with normal weight as well as obese patients.

How Is Type 2 Diabetes Treated With Metabolic Surgery?

Diabetes is a metabolic disease with high blood sugar levels. The hormone insulin secreted from the pancreas regulates the glucose metabolism in the body. In the case of decreased insulin secretion from the pancreas, the cell entry of glucose will be disrupted, and the glucose level in the blood will increase, leading to the development of diabetes.

In metabolic surgery, a part of the stomach is removed and its connection with the small intestine is rearranged. This operation also causes changes in various gut-derived hormones that control the secretion and action of insulin. Metabolic surgery improves Type 2 diabetes as a result of multiple factors. Some of these are increased incretin levels, decreased anti-incretins, decreased ghrelin levels, increased leptin activity, rapid gastric emptying, calorie restriction, and weight loss.

What Are Incretins?

Incretin; They are intestinal chemicals that increase insulin secretion in the presence of glucose, that is, blood sugar. The most important incretin is GLP1 (Glucagon-like peptide-1), which is secreted by food contact into the ileum, the last part of the small intestine. In metabolic surgery, as the composition of the small intestine is rearranged, food reaches the ileum more quickly, leading to early production of GLP 1. The increase in the number of GLP-1 insulin-producing cells causes these cells to hypertrophy and increase in size. This leads to increased insulin production.

What Are Anti-incretins?

Anti-incretin; These are chemicals that are released as a result of the duodenum, the first part of the small intestine, that is, the duodenum, encountering food. It has negative effects on insulin and causes blood sugar to rise. If the duodenum is bypassed in metabolic surgery, foods do not enter the duodenum and therefore antiincretin levels decrease. This directly reduces the negative effects on insulin.

What is Ghrelin?

Ghrelin, known as the hunger hormone; It plays a role in energy balance and regulation of food intake. Ghrelin, secreted from the upper part of the stomach called the fundus, also has negative effects on insulin. In sleeve gastrectomy, which is a part of metabolic surgery, fundus is removed and ghrelin production is reduced. This directly eliminates its negative effect on insulin.

What is the Effect of Accelerated Gastric Emptying?

The sleeve gastrectomy method, which is preferred in the treatment of obesity, has a positive effect on the normalization of blood sugar levels in terms of allowing the stomach to empty quickly. Thus, it balances the slowing effect of GLP-1 on gastric emptying by causing rapid entry of food into the small intestines.

What is the Effect of Calorie Restriction?

Sleeve gastrectomy, which is a part of metabolic surgery, reduces the stomach volume and limits food and therefore calorie intake. Decreased calorie intake increases the number of insulin-sensing receptors in cells and insulin sensitivity. In this way, blood sugar returns to normal levels. Sleeve gastrectomy is applied in diabetic patients with normal weight, not for weight loss, but for calorie restriction. In obese diabetics, it is performed to provide more calorie restriction and weight loss.

What is the Effect of Weight Loss?

Sleeve gastrectomy, also known as sleeve gastrectomy surgery, leads to calorie restriction and weight loss. Weight loss has a positive effect on maintaining normal blood sugar levels. Weight loss increases insulin activity and reduces cell damage in pancreatic beta cells. Weight loss is not targeted in metabolic surgery performed in normal weight diabetic patients.

What are the Types of Laparoscopic Metabolic Surgery?

All obesity surgeries are called metabolic surgery because they provide the improvement of metabolic diseases such as diabetes in a significant number of patients. There are also surgeries designed to treat type 2 diabetes. These can be applied to both obese and normal weight diabetics. The most popular ones are Transit Bipartition (TB), Loop TB (SASI: Single Anastomosis Sleeve Ileostomy), Laparoscopic Sleeve Gastrectomy + Duodenoileal interposition, Laparoscopic Sleeve Gastrectomy + duodenojejunal Bypass, Laparoscopic Sleeve Gastrectomy + Jejunoileal interposition (diverted-nondiverted) surgeries.

Who is Eligible for Metabolic Surgery?

Patients who meet the following criteria are eligible for metabolic surgery;

Patients with Type 2 diabetes with a body mass index of 40,
Body mass index is between 35 and 40 and sugar control cannot be achieved despite medication and lifestyle changes,
Patients with Type 2 diabetes, whose body mass index is between 30 and 35, and whose sugar control cannot be achieved with medical treatment, including insulin…

Who is Not Eligible for Metabolic Surgery?

Patients with type 1 diabetes, suffering from other endocrine diseases, and severe heart and respiratory diseases that would prevent surgery are not suitable candidates for metabolic surgery. Metabolic surgery is not beneficial in type 1 diabetes because there is no or very little insulin secretion. It is best to perform the surgery in the early stages of the disease.

What are the Results of Metabolic Surgery?

Diabetes improves in 95 percent of patients after metabolic surgery. HbA1c levels fall below 6 in more than 65 percent of patients and stay between 6 and 7 in 30 percent. Patients completely stop using insulin and tablets.

What are the Factors Affecting Recovery in Type 2 Diabetes?

The duration of diabetes, the insulin requirement before the surgery, the age of the patient and the amount of insulin secretion in the body are the main factors affecting the improvement in diabetes.

What Tests Are Required Before Metabolic Surgery?

Before metabolic surgery, a complete evaluation of the patient’s heart-respiratory systems is first performed. Fasting and postprandial blood glucose levels, HbA1c, postprandial C-Peptide and anti-GAD antibody levels are measured. Damage to kidneys and eyes caused by diabetes should also be evaluated in patients.

What are the Complications of Metabolic Surgery?

There are some complications that may occur in the early and late period after metabolic surgery. The incidence of these non-life-threatening complications is very low. Some possible problems are leakage from the staple line, need for postoperative respiratory support, lung infection, clot formation in the leg veins, intestinal obstruction and difficulty urinating in the early period. All these problems are rare and can be successfully treated if detected early. Compared to the risks caused by diabetes, the risks of surgery remain extremely low.

What is the Effect of Metabolic Surgery on Large Veins?

Diabetes causes narrowing of the vessel walls in various parts of the body. Decreased blood flow to various organs such as the heart, brain, legs and penis in men can lead to heart attack, stroke, ulcers in the legs, gangrene and erectile dysfunction. Complications can be avoided or delayed for years if surgery is performed before these problems develop. If the patient has these problems, the worsening can be stopped and the blood flow and related problems can be improved.

What are the Microvascular Effects of Metabolic Surgery?

Increased blood sugar levels and fluctuations in blood sugar impair the functions of some organs and tissues apart from the kidney, eye and retina. This can lead to kidney failure and loss of vision. Metabolic surgery prevents fluctuations by returning the blood sugar level to normal. If these problems are not present during the surgery, their occurrence can be prevented and delayed for years.

How Much Does Metabolic Surgery Cost?

Bariatric and metabolic surgeries are relatively expensive surgeries. Most of the costs are due to the special materials used such as staplers. In terms of excellent long-term results, metabolic surgery should be considered as an investment in a healthy life in the future. You can contact us for more information.

How Is Type 2 Diabetes Treated With Metabolic Surgery?

Type 2 diabetes, which accounts for approximately 95 percent of all diabetes-related cases, is a chronic metabolic disorder that occurs when the body does not produce enough insulin or cannot use the insulin it produces effectively. Current treatment for type 2 diabetes includes lifestyle intervention and anti-diabetes medication. Therefore, diabetes surgery is a form of treatment for the permanent solution of diabetes. Diabetes surgeries performed keep the patient’s blood sugar level under control. With this treatment method, it is aimed that the patient continues his life without medication or being less dependent on drugs.

What is the difference between diabetes surgery and bariatric surgery?

Diabetes surgery, unlike bariatric surgery, focuses on controlling metabolic diseases, not just overweight. Our clinic also pioneers many treatments in the field of diabetes surgery.

About Type 2 Diabetes

Type 2 diabetes; It is a condition in which blood sugar rises due to the inability of the pancreas to secrete enough insulin. Obesity and physical inactivity, especially genetic predisposition, are among the factors that trigger Type 2 diabetes.

High blood sugar in type 2 diabetes patients; There are two causes of insulin secretion deficiency and insulin resistance. Insulin resistance is a condition in which there is enough insulin in the blood, but it cannot show its effect. If left untreated, this resistance; can lead to elevated blood sugar or sugar levels, which can adversely affect various organs and tissues, including the heart, kidneys and eyes.

Not all type 2 diabetes patients are candidates for surgical treatment. A number of tests are required to determine whether patients will benefit from surgical treatment. According to the results of these tests, it is determined whether insulin is still secreted from the patient’s pancreas. If the results are suitable for the surgical treatment of diabetes, the patient is prepared for surgery. A number of evaluations are made about whether the patient will benefit from surgical treatment. These are the duration of diabetes, that is, how many years ago it started, whether the patient is obese, the patient’s age, and the C-peptide levels in the blood.

Advantages of Diabetes Surgery

The purpose of diabetes surgery; It is to increase the quality of daily life of the patient by using different methods, to relieve their pain and psychological negativities due to their diseases. The advantages of diabetes surgery, especially in morbidly obese individuals, are as follows:

Alleviating diabetes by normalizing the blood sugar level without medication,
Controlling diabetes with less medication by significantly lowering blood sugar levels…

Diabetes surgery; In addition to controlling diabetes and helping weight loss, it can help patients in the following ways.

To improve metabolic disorders such as hyperlipidemia, hypertension and sleep apnea,
Reducing the possibility of cancer formation and prolonging life expectancy.

What is the Approach to Diabetes Surgery?

Before benefiting from diabetes surgery, patients with Type 2 diabetes should first do diet and sports. In addition to exercise and diet, if the doctor deems it necessary, medication should be applied to the person at the same time.

If the drugs used, exercise and diet continue to negatively affect the daily life of the person instead of helping the disease to get better, the patient can be treated with the help of diabetes surgery. In this context, patients who come to our clinic;

Allows patients interested in diabetes surgery to learn about current procedures by listening to their health goals,
Thanks to our internal dietitian service, we help patients make the right dietary choices for them and provide the necessary psychological support regarding the clinical treatment process.