TYPE 2 DIABETES (TRANSIT BIPARTITION) SURGERY

 

 

 

The procedure

combines a typical

sleeve gastrectomy

(SG) with a transit

bipartition (TB).

 

This creates a shortcut to the ileum while maintaining access to the duodenum. The procedure may be performed in a  laparoscopically, where the SG is performed through laparoscopy . Here, we describe the laparoscopic method. Pneumoperitoneum is obtained using a Veress needle. Six trocars are positioned, including three 12-mm trocars (1 in the midline 3 to 5 cm above the umbilicus and 2 others in the upper left and right quadrant) and three 5-mm trocars (1 in the epigastrium for the liver retractor and 2 at each lateral flank). The omental bursa is opened, and the greater omentum is sectioned with a sealer and divider device (Ultracision or Ligasure).

The greater curvature is freed from 2 cm proximal to the pylorus up to the angle of His, including the left arm of the hiatal crura. If a hiatal hernia is present, then a hiatoplasty is performed. A typical sleeve gastrectomy15 is performed with a laparoscopic linear cutting stapler starting at the gastric greater curvature at a point located 4 to 5 cm from the pylorus up to 0.5 cm from the angle of His. A 33-45 French bougie is passed to the stomach to guarantee that the remnant gastric tube, which is positioned by the lesser curvature, has an internal lumen 3-cm wide. A seromuscular running suture is sometimes used to cover the stapling line to reduce bleeding. After the SG, the ileocecal transition is located. A single stitch is used to mark the point at the ileum 80-150 cm from the ileocecal valve. The point at 230-300 cm is then located, and a perforation is made with the cautery to allow the insertion of one arm of the linear stapler into the ileum lumen. Another hole is created in the stomach antrum at the end of the stapling line by applying the cautery against the bougie’s protuberance. The other arm of the stapler is inserted in the stomach from the patient’s left to the right, toward the pylorus, to create a 3- to 4-cm wide latero-lateral gastroileal anastomosis in an antecolic position. A 3-0 absorbable extra mucosal running suture closes the residual defect. In the following sequence, the small bowel cranial to the gastroileal anastomosis is laterally widely anastomosed to the ileum at 80-150 cm from ileocecal valve (previously marked) in a lateral-lateral mode. A laparoscopic linear stapler with a 60-mm white cartridge is used for the anastomosis). A nonabsorbable running suture closes the mesenteric borders to prevent internal hernias. At the end of the procedure, the segment between both anastomoses is interrupted with stapling and cutting. A closed suction drain, lying along the sleeve gastrectomy staple line, is exteriorized through the lower left port incision. The other laparoscopic incisions are closed.

 

​What is metabolic syndrome?

Metabolic syndrome is a cluster of conditions associated with obesity, hypertension, diabetes, high blood lipids (elevated triglyceride and cholesterol) and hepatosteatosis.

 

What is metabolic surgery?
​Even though it is known as diabetes surgery, it includes treatment of all conditions composing metabolic syndrome.

Which type of diabetes is treated with metabolic surgery? Metabolic surgery is performed for only type 2 diabetes. This surgery does not cure Type 1 diabetes.

 

Is being morbidly obese necessary for this surgery?

The major difference between metabolic surgery and obesity surgery is that metabolic surgery can also be performed for non-morbidly obese patients.  Here, BMI threshold is 27.5. In other words, Grade 3 obesity for BMI above 40 or even Grade 2 obesity for BMI above 35 is not required. 

 

Who is candidate for the surgery?

Any patient with Diabetes Mellitus Type 2 is an ideal candidate for this metabolic surgery. Patients whose glucose does not return to normal levels despite medication or insulin is suitable. Diabetic patients with severe weight problem (BMI above 35).​


 

Average length of stay ın Istanbul

Recovery duration is 10-12 days

Length of stay in hospital

5 days

Operation duration and Anesthesia

2-3 hours General Anesthesia

WORK

After 2 weeks

Global Patient Services

Each year, Our Clinic treats hundreds of patients from around the world. For patients who travel outside of their home country to receive services at a Istanbul location, our Global Patient Services team offers seamless care designed specifically to your unique needs and culture.

Experienced center

Our pioneer team has experience over 10 years. More than 30 operations are performed per month

Safe Procedure

Weight-Loss Surgery May Reduce Heart Risks in People With Type 2 Diabetes" 
 2019- The New York Times
​"Weight-Loss Surgery Has Other Benefits: Easing Diabetes and Heart Disease"
" Weight-Loss Surgery Better Than Diet and Exercise in Treating Type 2 Diabetes, Study Finds"
2019- Wall Street Journal

Our Surgeon

He was a member of the surgery team, that  performed the first Laparoscopic Metabolic Surgery (Diabetes Type 2) in 2009. He has performed more than 1000 Bariatric and Metabolic Surgeries.

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