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

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

How is Type 2 Diabetes Corrected with Metabolic Surgery?

Diabetes is a metabolic disease that progresses with high blood sugar. The insulin hormone secreted from the pancreas regulates glucose metabolism in the body. If insulin secretion from the pancreas decreases, the entry of glucose into the cells will be impaired, 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 intestinal hormones that control the secretion and action of insulin. Metabolic surgery cures Type 2 diabetes as a result of multiple factors. Some of these are increase in incretin levels, decrease in anti-incretins, decrease in ghrelin level, increase in leptin activity, rapid emptying of the stomach, 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) and is secreted by food contact into the ileum, the last part of the small intestine. Since the composition of the small intestine is rearranged in metabolic surgery, food reaches the ileum faster, leading to the premature production of GLP 1. The increase in the number of GLP-1 insulin-producing cells causes hypertrophy of these cells and their increase in size. This leads to increased insulin production.

What are anti-incretins?

Anti-incretin; They are chemical substances 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 its negative effects on insulin.

What is Ghrelin?

Ghrelin, known as the hunger hormone; It plays a role in regulating energy balance and nutritional 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, the 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 as it ensures rapid emptying of the stomach. Thus, it balances the slowing effect of GLP-1 on gastric emptying by causing food to enter the small intestines quickly.

What is the Effect of Calorie Restriction?

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

What is the Effect of Weight Loss?

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

What are the Types of Laparoscopic Metabolic Surgery?

All obesity surgeries are called metabolic surgery because they provide relief from 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 among these is 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 Suitable for Metabolic Surgery?

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

Type 2 diabetic patients 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 cannot be controlled with medical treatment, including insulin.

Who is Not Suitable for Metabolic Surgery?

Patients with type 1 diabetes, other endocrine diseases, or heart and respiratory diseases that 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 release. It is best to perform 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 remain between 6 and 7 in 30 percent. Patients completely stop using insulin and tablets.

What are the factors affecting recovery in type 2 diabetes?

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

What Examinations Are Required Before Metabolic Surgery?

Before metabolic surgery, a complete evaluation of the patient’s cardiorespiratory systems is first performed. Fasting and postprandial blood sugar levels, HbA1c, postprandial C-Peptide and anti-GAD antibody levels are measured. The damage caused by diabetes to the kidneys and eyes 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 periods after metabolic surgery. The occurrence of these non-life-threatening complications is very low. Some possible problems are leakage from the staple line, need for respiratory support after surgery, lung infection, clot formation in the leg veins, intestinal obstruction, and early urination difficulty. All these problems are rare and can be treated successfully if detected early. Compared to the risks caused by diabetes, the risks of surgery are extremely low.

What is the Effect of Metabolic Surgery on Large Vessels?

Diabetes causes narrowing of the vessel walls in various parts of the body. Reduced blood flow to various organs such as the heart, brain, legs and, in men, the penis, can lead to heart attack, stroke, leg ulcers, gangrene and erectile dysfunction. When surgery is performed before these problems develop, complications can be avoided or delayed for years. If the patient has these problems, their worsening can be stopped and 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 disrupt the functions of some organs and tissues other than the kidneys, eyes and retina. This condition can lead to kidney failure and vision loss. Metabolic surgery prevents fluctuations by returning blood sugar levels to normal. These problems can be delayed for years by preventing them from occurring during surgery.

How Does Metabolic Surgery Cost?

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

How is Type 2 Diabetes Corrected with Metabolic Surgery?

Type 2 diabetes, which accounts for approximately 95 percent of all cases of diabetes, is a chronic metabolic disorder that occurs when the body does not produce enough insulin or cannot effectively use the insulin it produces. Current treatment for type 2 diabetes includes lifestyle intervention and anti-diabetes medications. 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, the aim is for the patient to continue his life without medication or with less dependence on medications.

What is the difference between diabetes surgery and obesity surgery?

Diabetes surgery, unlike obesity surgery, focuses on controlling metabolic diseases, not just excess weight. Our clinic, diabetes surgery