Ileal Transposition: A Surgical Breakthrough in Bariatric Surgery
Aureo de Paula, a Brazilian surgeon, pioneered the ileal transposition procedure in bariatric surgery. The surgery aims to set aside insulin resistance hormones and increase the sensitivity of other hormones. Bariatric surgeons perform ileal transposition through minimally invasive surgical incisions
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| Recovering from Bariatric Surgery |
1. Mechanism of Action: Ileal transposition involves moving a portion of the ileum (the lowest part of the small intestine) closer to the stomach. This relocation alters the flow of nutrients and hormones in glucose metabolism, and appetite regulation improves glycemic control and weight loss.
2. Dual Benefit for Diabetes and Obesity: While initially developed to address obesity, ileal transposition has shown significant benefits for type 2 diabetes. It promotes weight loss but enhances insulin sensitivity and reduces blood sugar levels.
3. Hormonal Changes: The rearrangement of the ileum affects the secretion of gut hormones such as GLP-1 (glucagon-like peptide-1) and PYY (peptide YY), which play prime roles in regulating appetite and glucose metabolism. These hormonal changes contribute to the metabolic improvements seen after ileal transposition.
4. Sparing the Stomach and Duodenum: Unlike other bariatric procedures like gastric bypass, ileal transposition leaves the stomach and duodenum (the first part of the small intestine) intact. This preservation may reduce the risk of certain nutritional deficiencies and complications associated with altering these organs.
5. Potential Long-Term Effects: While ileal transposition has shown promising short-term outcomes in weight loss and diabetes control, more research is needed to understand its long-term efficacy and safety profile. Studies investigating the durability of metabolic improvements and potential complications over extended periods are ongoing.
6. Considerations for Patient Selection: Patient selection is crucial for the success of ileal transposition. Candidates typically include individuals with type 2 diabetes or obesity who have not responded well to conventional treatments and who meet specific criteria regarding BMI and overall health.
7. Evolution of Surgical Techniques: The technique for performing ileal transposition has evolved, with variations in the length and placement of the transposed ileal segment. These modifications aim to optimize outcomes while minimizing risks and complications associated with the procedure.
8. Multidisciplinary Approach: As with other metabolic surgeries, ileal transposition requires a multidisciplinary approach involving surgeons, endocrinologists, dietitians, and other healthcare professionals. Comprehensive preoperative evaluation, postoperative monitoring, and long-term follow-up are essential for successful treatment.
What essential information should we understand regarding ileal transposition?
Doctors removed insulin resistance hormones such as ghrelin, GIP (gastric inhibitory polypeptide), and glucagon from the first part of the digestive system. They exchanged with the sensitive hormone GLP-1 from the L cells in the last part of the intestine. GLP-1 is a hormone that increases the effects of insulin and stimulates insulin production by the pancreas. Your doctor may achieve blood sugar control in patients within ten days to six months.
The procedure causes a sharp rise in insulin shortly after eating, controlling postprandial (after-meal) sugar. It also enhances the insulin sensitivity of target cells, enabling improved regulation of fasting sugar levels influenced by the liver.
What are the types of ileal transposition?
Just beyond the stomach, a portion of the small intestine's last section (the ileum) gets sandwiched between two sections of the small intestine (the jejunum).
There is no bypass or removal of any portion of the small intestine. Two types of ileal transposition exist: conventional and non-conventional. Ileal transposition is more straightforward, with diabetes resolution rates up to 90%. The second one controls diabetes and other metabolic syndromes by over 95% with complex diverted ileal transposition.
What are the symptoms that can lead to ileal transposition?
Your early signs and symptoms can include frequent urination, increased thirst, tiredness and hunger, vision problems, and slow wound healing associated with obesity.
What are the principal causes of ileal transposition?
Type 2 diabetes associated with high obesity is the cause of bariatric ileal transposition.
- Obesity and type 2 diabetes will shorten life expectancy, decrease quality of life, and increase healthcare costs.
- Obesity and diabetes are on the rise.
- Recent data proves that reduced body weight improves glycemic control, mortality, and morbidity.
- In a few cases of natural diabetic conditions leading to excessive weight gain, patients may require ileal transposition surgery.
- Ileal interposition is a metabolic surgery technique used to treat obese diabetic patients.
- Although traditional bariatric surgery treats diabetes in obese individuals, some procedures, such as ileal interposition, treat diabetes in patients who are not overweight.
- Surgeons conduct ileal transposition via laparoscopic or keyhole approaches, anticipating improved glycemic control in specific type 2 diabetes patients.
What is the possible structure of blood sugar control?
The prospective mechanism for controlling blood sugar levels in diabetic patients will take ten days to six months. One or more factors will be involved in blood sugar regulation. Early contact of undigested food (chyle) with the intervening segment of the ileum causes GLP-1 hormone levels in the blood.
- The effects of GLP-1 can be as follows:
- Glucose, even in the presence of severe ß-cell dysfunction
- Stimulation of insulin secretion
- On pancreatic ß, it has a proliferative impact.
- Acute insulin response, which gets frequently lost in type 2 diabetics, is thought to be the result of this, and finally, this may end in quick blood sugar regulation after a meal.
When do you need to see a doctor?
If your body mass index (BMI) falls within the range of 30–40 and your blood glucose levels remain high despite treatment, it is advisable to consult a doctor.
What are the benefits of ileal transposition?
Ileal transposition offers two prime advantages and one disadvantage. The first benefit is that doctors can perform it on patients with a wide range of BMIs. The second is that it does not need extra vitamin supplementation, except for patients who need iron, B12, or vitamin D supplementation before surgery.
What are the potential risks, complications, and activities after ileal transposition?
Many surgeons have noted the risk of infection, excessive bleeding, blood clots, breathing problems, and leaks in your GI tract after ileal transposition. Ileal transposition causes minor complications like vomiting, esophagitis, bowel obstruction, gout, and urinary tract infections. Your doctor recommends that you resume physical activity following surgery to maintain a high metabolic rate.
Conclusion
- Doctors refer to diabetes caused by obesity as diabesity.
- Ileal transposition surgery is a type of metabolic surgery used to treat diabetic patients who are overweight.
- It involves many stages, requiring extensive preparation and surgical experience for surgeons.
FAQs:
What is the relationship between obesity and diabetes?
- Obesity raises the risk of having type 2 diabetes, the most prevalent type of diabetes. With this condition, the body produces enough insulin, but the body cells become highly resistant to insulin's effects.
What is the goal of the ileal transposition procedure?
- The ileal transposition procedure aims to reduce resistance hormones while increasing sensitivity hormones.
How much time does it take to recover from surgery?
- Commonly, recovery occurs on the same day. Surgeons encourage patients to walk by evening. Some patients, however, will return to work two weeks after leaving the hospital. Your doctor can prescribe a specific diabetic diet. Your doctor can observe a remarkable glycemic improvement after ileal transposition.