Evolutionary Reasons of Obesity and Diabetes
Humans learned to prepare their food by picking the wealthiest parts of it and disregarding the low nutritive components. However, extremely different from various other animals, we began food preparation, boiling, as well as liquefaction of food to make nutrients more available.
From an evolutionary point of view, the food industry recently created extremely new processes, such as refining, extrusion cooking, surge puffing, utilizing extreme temperature levels and stress. Such extremes assist in the food digestion of starches. In fact, these procedures work as exterior digestion.
Industrialization made refined food readily available, plentiful, and low-cost. In the last 4 decades, a high rise in the incidence of obesity and related conditions has been observed in well-off, industrialized areas.
Gut is the Key in Diabetes
In 1998, the world was captivated by a study that investigated whether type 2 diabetes mellitus (T2DM) could be a disease of the foregut. The nonrestrictive and non-malabsorptive effects of bariatric surgical treatment became a subject of interest.
Big meta-analyses showed that the bariatric treatments that work best (in terms of weight loss and metabolic enhancement) are those that minimize the quantity of food that is presented to the foregut and that boost transport of food to the hindgut.
Progressively, it became clear that restriction and malabsorption were not the main causes for the great outcomes of present bariatric treatments. This technique consisted of various treatments capable to trigger metabolic improvements. Among them, it was observed that sleeve gastrectomy and transit bipartition were highly efficient.
The main goal of transit bipartition is to benefit our patients by counterbalancing the dangerous effects of the modern diet. Without exceptions and with a basic operation, SG + TB amplifies the nutritious stimulation of the distal gut while simultaneously lessening the exposure of the proximal bowel to nutrients without totally deactivating duodenum and jejunum.
What is the Transit Bipartition Surgery?
Transit bipartition surgery, also known as surgical treatment of diabetes, is a type of surgical operation that is carried out amongst the metabolic surgery procedures, which is perfect for Type 2 diabetes mellitus patients with an excess weight issue, and which is generally done by laparoscopic method.
The procedure combines a typical sleeve gastrectomy with a connection between stomach and the distal small bowel; this creates a faster way to the ileum while preserving access to the duodenum. After this operation, in which the continuity of the stomach and duodenum is preserved, there is no severe reduction in the absorption of minerals and vitamins necessary for the body.
Very impressive and reliable outcomes are acquired with the transit bipartition surgery executed for the therapy of individuals with Type 2 diabetes mellitus. After the operation, which is finished in approximately 1 hour, individuals can get rid of type 2 diabetes, lose their excess weight, and improve their health problems due to excess weight.
Who Is a Good Candidate for Transit Bipartition Surgery?
Transit bipartition, which is a metabolic surgical procedure approach developed for Type 2 diabetes treatment, also makes it possible for patients with a body mass index more than 35 to lose weight securely.
Individuals that have a Body Mass Index of 35 and above
Individuals that have Type 2 Diabetes (in this group BMI criteria goes down to 30)
Whose general health and wellness is at risk from being overweight and having diabetes
The basic state of health is thought to be appropriate for surgery
Who wishes to lose weight and are prepared for the post-operative process
People with the necessary psychological conditions for the procedure
How is Transit Bipartition Surgery Performed?
Transit bipartition operation would be performed under general anesthesia and finished usually in 1 hour. During the surgery utilizing the laparoscopic approach, small cuts will be created on the abdominal area. Because of this, the recovery and healing period after transit bipartition with keyhole technique would be faster and more comfortable than open surgery.
Stage 1: Sleeve Gastrectomy
First, a standard sleeve gastrectomy procedure would be carried out. The new stomach created after stomach surgery performed as part of transit bipartition is slightly larger than the stomach developed during traditional sleeve gastrectomy operation.
Stage 2: Intestinal Bypass
In the second stage, the initial 250 centimeters of the small intestine (with a length of 5 meters) is preserved and the small intestine is cut in half from the marked component. The cut part is incorporated into the shrunken belly and the free portion is incorporated in the last 150 cm of the small intestine.
This way, when the individual eats, the receptors in the middle part of the small intestine feel quickly, and the risk of absorption troubles is eliminated as the consumed food passes all parts of the small intestine.
Approximately one-third of the food eaten by the individual after the transit bipartition surgery goes through the duodenum, while the other part goes through the new connection made from the middle part of the small intestine.
Advantages
The stomach is shrunk but the risk of leakage is reduced since the stomach pressure will not be as high as sleeve
When the stomach is shrunk, the part that releases Ghrelin is removed, which causes consequently lowering cravings
After the surgery, the duodenum is not impaired
The natural way of the digestive system is preserved and easily accessible when endoscopy is needed
⅓ of food can travel through the normal gastrointestinal system, no extreme absorption problem happens
Vitamin, mineral, iron, and calcium supplements are not generally needed long-term
Type 2 diabetes mellitus resolves without waiting to lose excess weight
Things to Consider
If the clients do not comply with the necessary controls after the operation, there might be no resolution in diabetes
There is a risk of leak as in gastric sleeve procedures - surgeon experience is crucial
Complication and risk rates in all laparoscopic surgeries are also valid (though extremely low in healthy patients)
Outcomes of Transit Bipartition
Complete Diabetes Remission
Orthopedic Pain Resolution
No Longer Need BP Medicine
Hypertriglyceridemia Treated
From a nutritional perspective, SG + TB has exceptional results. Protein malnutrition will not occur. Anemia is rarely a trouble and typically temporary. Regarding Type 2 diabetes, 86% of patients show complete remission; 14% of people show improvements but still need some oral diabetes pills.
Perioperative Treatment & Follow-ups
Immediate Care
- • Antibiotic and deep vein thrombosis treatment
- • Low molecular weight heparin shots
- • Anti-thrombosis socks
- • Fasting on first postoperative day
- • Liquid supplements for subsequent 12 days
- • Soft solid meals with slow progression
Follow-up Schedule
- • Return after 10 days
- • 1 month check-up
- • 3 months check-up
- • 6 months check-up
- • 1 year check-up with blood tests
- • Annual visits thereafter
Is Transit Bipartition Right for You?
Contact Dr Murat Ustun's team today for a free consultation to determine if transit bipartition surgery is the right option for your diabetes and weight management goals.