When it comes to diabetes, although there are intermediate forms, type 1 and type 2 diabetes come to mind. In type 1 diabetes, there is insufficient insulin secretion in the pancreas, while in type 2 diabetes there is generally sufficient insulin secretion in the pancreas, but this insulin cannot be used by tissues. While metabolic surgery operations can only be treated with type2 diabetes, patients with type 1 diabetes cannot be treated.
What is metabolic surgery
Obesity surgeries have been performed all over the world for years. Not only obesity, but also chronic diseases such as diabetes and hypertension regress after the treatment. Considering this effect, metabolic surgery surgeries have been developed.
Which surgeries are used as metabolic surgery method
Gastric bypass, Duodenal Switch and SleeveGastrectomy (Tube stomach) operations for obesity surgeries are all metabolic surgery surgeries. In addition, operations such as Transit Bipartition, IlealTransposition and Jejunoileal bypass are especially developed for patients with diabetes disease.
All of these surgeries are performed by closed method (laparoscopic). It is made by entering the abdomen through 4-5 holes, the sizes of which vary between 0.5 - 12 mm. Patients can be mobilized on the same day since there is no major incision after the operation, and they are discharged 3-5 days after the hospital depending on the type of surgery.
Mechanism of effect
While some of the surgeries used in metabolic surgery are restricting the amount of nutrients ingested, the other part is surgeries that both limit the amount of nutrients taken and which affect the absorption of nutrients from the intestine. In addition, most of the nutrients ingested today are absorbed in the upper parts of the intestines before they reach the bottom of the intestines. Therefore, hormones secreted from the lower part of the intestine and regulating the release of insulin from the pancreas cannot be activated sufficiently.
With the metabolic surgery operations, either the last part of the intestine is replaced with the upper bowel loop, or by the bypass procedures, the food reaches the last part of the intestine more quickly. Thus, foods that reach the last part of the intestine more easily ensure hormone secretion from here, and these secreted hormones facilitate the use of insulin in the pancreas in the body.
Who can have these surgeries
Metabolic surgery operations are performed on type2 diabetes patients who cannot be controlled despite medical treatment. The main problem in patients with diabetes is the damage to large and small vessels over time, as a result of which organ damage such as heart, kidney, liver and eyes. While making the decision for surgery, the last 3 months of fasting glucose value, body mass index, whether or not diabetes control can be achieved despite medical treatment, organ damage, and the state of the insulin reserve in the pancreas should be taken into consideration. Those who do not have Type1 Diabetes do not have these surgeries.
Metabolic surgery operations are operations performed with a closed method and the risks of the operation are not more than the risks of gallbladder or obesity surgeries. However, there are few risks that can be seen such as bleeding, leakage, clot formation and internal hernia development. Many of these risks are those that can occur after each abdominal operation. In addition, when talking about the risks of surgery, it should be remembered that the risk of organ damage that will develop as a result of not having surgery is much higher than the risk of surgery.