The group of operations we call metabolic surgery consists of a large number of operations. These operations have been applied for more than 60 years in Europe, Turkey, North America, Brazil and other countries. They are grouped as metabolic surgery because of the effects they cause and the consequences of these.
These operations begin initially as an obesity surgery. They are mainly aimed at reducing the stomach and limiting the function of the small intestine. The aim is to activate certain parts of the small intestine of different lengths through various operations. Significant weight loss is not the only positive effect after these operations. Improved metabolism, blood glucose control, reduces the risk of cardiovascular disease, increased cholesterol and diabetes. These operations show a good metabolic effect, beyond weight loss. For this reason, these operations are no longer referred to simply as obesity surgery, but they accept the broader name – metabolic surgery.
In recent years, in a few countries around the world – Brazil, Japan, India, America, Italy and Turkey – this new surgical method has been used to treat type 2 diabetes that achieves impressive results.
What underlies these impressive results. The effect is mainly due to the replacement of the initial part of the small intestine with the end part. This process is important to increase the secretion of GIP-1 hormone. This hormone stimulates insulin production from the pancreas and improves insulin action. GIP-1 is secreted at the end of the small intestine. The last part of the small intestine is called ileum, so the operation is called “ileal interposition” and is a bowel movement, in which, in a very powerful way, compared to all drugs and insulin, the damage to the beta cells that underlie the diabetes mellitus. With this new regulation created in the digestive system, a wide variety of metabolic changes have been triggered. These metabolic changes allow for the normalization of the metabolic syndrome, especially in diabetes. The operation is laparoscopic and is performed through 6 small openings without incisional abdomen. The results are more than impressive – 85% of patients are discharged from the hospital completely independent of insulin. In 10% of them, medication is reduced and stopped within a few months. In 5% of the patients, insulin is reduced and blood glucose control is better.
The metabolic effect of the ileal interposition is mainly due to the hormonal changes that result from the ileum shift. During the operation, a part of the stomach from which the hormone of hunger ghrelin is released. Glarine is a hormone that affects insulin resistance. In patients with type 2 diabetes, this hormone doubles. After surgery, levels of the ghrelin hormone are lowered to very low levels. Reduction of ghrelin hormone eliminates a factor that suppresses the effects of insulin hormone and reduces the feeling of hunger.
As a result of these hormonal changes, the feeling of hunger is suppressed. In particular, insulin resistance is suppressed in muscle and adipose tissue and the pancreatic capacity increases twice. This effect is called the “nerve endocrine disruption”. This refers to a type of complex nervous-humoral system that originates from the base of the brain-hypothalamus and acts on the endocrine system. All the consequences after surgery are due to the regulation of hormone secretion, which will increase the effect of insulin and reduce insulin resistance.
In conclusion, the “ileal interposition” affects the digestive system and improves metabolism. This surgery is suitable for patients with type 2 diabetes aged between 18 and 70 years who have been diagnosed more than 2 years ago and who fail to control blood glucose levels with standard treatment. It is not used in patients with diabetes 1 and those who successfully control their disease with medication.
Dr. Turgul Demirel is one of the leading experts in the Republic of Turkey, and in the world who are implementing this unique operation. He applies 12 types of diabetic surgery, following a rigorous analysis of the general condition of the patient, and deep judgment uses the most appropriate surgery, and the benefits to the patient’s physical condition are incomparable.