Surgical Methods Used in the Treatment of Type 2 Diabetes


Diabetes mellitus is a disease that occurs due to insufficient secretion or ineffectiveness of the insulin hormone produced in the pancreas, the inability of sugar molecules passing from the intestines to the blood, and their accumulation in the blood. A fasting blood sugar above 126mg/dl or a postprandial blood sugar above 200mg/dl is sufficient for the diagnosis of diabetes. Individuals with a fasting blood sugar of 100-126mg/dl have impaired glucose tolerance and their diabetes status is checked by performing the Oral Glucose Tolerance Test (OGTT). It is broadly classified as Type I and Type II. There are also some intermediate forms of these two types. Type I diabetes usually develops as a result of the destruction of insulin-producing cells after some infectious diseases in childhood or adolescence, after autoimmune body defense attacks the pancreatic tissue. In its treatment, lifelong insulin is used. Type II diabetes usually occurs in obese individuals in adulthood. Due to the excess fat in the cells, there is resistance to insulin at the cellular level and insulin does not have an effect even though it is secreted from the pancreas. Since there is not enough sugar fuel inside the cells, they cannot produce energy and do not perform their duties fully. Excess sugar accumulated in the blood is tried to be excreted by the kidneys. Kidneys, eyes, nerves, vessels and various tissues and organs are affected by high blood sugar and begin to deteriorate over time. In the treatment of type II diabetes, various tablets and insulin are used together with diet. When patients lose weight, they can get rid of diabetes because insulin resistance decreases.


One of the reasons for the rapid increase in type II diabetes (diabetes) in the form of a serious epidemic in the world today is the western type of diet. With this diet, high-calorie refined foods are used. When this diet is combined with inactivity, it increases the tendency to obesity and diabetes. GLP-1 and some similar hormones are secreted from the last part of the small intestine called the ileum. The release of these hormones increases with the arrival of food in this region, but since refined foods are almost completely absorbed in the part of the intestines near the stomach, insulin resistance occurs because these hormones, which act as the opposite of insulin, are not activated with today’s diet.


Transit Bipartition surgery is the general name of the process of cutting the ileum, which is close to the large intestine, and connecting the lower part of the stomach to the stomach and the upper part of the stomach connection to this intestine in a Y shape after certain lengths, after the tube stomach surgery is performed on the patient.


SASI surgery is a different version of the Transit Bipartition procedure. A single intestinal connection is made to the stomach.


In ileal interposition surgery, the small intestine called ileum is brought closer to the stomach as a whole, and intestinal hormones are activated early. There are two different types as diverted and non-diverted. In the diverted type, the ileum is connected to the stomach, in the nondiverted type, it is placed between the jejunum, the part of the intestine near the stomach. It differs from TB in the absence of a deactivated part of the intestine that leads to malabsorption.


In jejunoileal by-pass surgery, the stomach is again turned into a tube and an anastomosis, that is, an interconnection, is created between the jejunum, the intestine close to the stomach, and the ileum, close to the large intestine, in a way that excludes some of the intestine. In this way, the absorption of food is reduced and the ileum hormones are activated.

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