Two mechanisms are used in obesity surgery. The first of these is a volume restricting mechanism, and the second is a mechanism that both restricts and impairs absorption from the small intestines. Adjustable gastric banding (clamp), one of the volume restricting methods, is rarely used today due to the complications it creates.

Today, we most commonly perform Sleeve Gastrectomy surgery, which we translate into Turkish as sleeve gastrectomy or stomach reduction surgery, as volume restricting surgery. The advantage of this surgery is that since there is no change in location in the digestive system and there is no need for vitamins and trace elements in the long term, more physiological results are obtained. Today, the most common malabsorption surgery is the one we call gastric bypass. In this surgery, both volume is restricted and absorption is impaired. As a result, while effective weight loss is achieved, vitamin and trace element supplements are necessary in the long term. If these patients who undergo surgery for the treatment of obesity have comorbid diabetes, an improvement of 40-60% can be achieved.

In the metabolic surgery methods we use in the treatment of type 2 diabetes, where obesity is not at the forefront, the healing effect of small intestine hormones is used. The fact that insulin resistance and type 2 diabetes are more common today than in primitive times is due to eating refined foods in parallel with industrialization. Digestion of refined foods is completed in the 70-80 cm jejunum section of the small intestine, close to the stomach. Small intestinal hormones that organize insulin release, which we call incretins, are secreted from the part of the small intestine that is closer to the large intestine, namely the ileum. The pulp of the digested and absorbed food reaching the ileum cannot ensure the release of incretins. As a result, ileum hormones that regulate insulin secretion, such as GLP-1, peptide YY, and oxyntomodulin, are not released sufficiently, and as a result, insulin resistance and subsequent type 2 diabetes occur. Therefore, in the metabolic surgery methods we use in the treatment of type two diabetes, it is aimed to connect the small intestine, which is closer to the large intestine, to the stomach, and as a result, to secrete an effective amount of small intestine hormones that will break insulin resistance. For this purpose, transit bipartition and ileal interposition surgeries are performed. The recovery rates in patients who undergo metabolic surgery for type 2 diabetes are much higher (85-95%) compared to obesity surgery.

Here, selection of patients who will benefit from metabolic surgery is very important. With a number of tests performed before the surgery, it is decided whether candidates with diabetes will benefit from metabolic surgery. Our target organs damaged by diabetes are primarily the eyes, kidneys, heart and nervous system. Our patients are informed about whether the damage to these organs will be reversible through the tests we will perform before the surgery. Therefore, individuals with type 2 diabetes should not live with diabetes for many years and should get rid of this disease by undergoing surgery as soon as possible.