#05. Operative Options of Type 2 Diabetes
How do we arrive at the decision to conduct a surgery?
The most important thing is to make sure that the patient does indeed have type 2 diabetes. Other than that, the patient must have an active insulin reserve; specific peptides that influence energy metabolism must also be present in the body, and the measurable insulin resistance must be high. It is also very important that blood sugar and other associated diseases are regularly treated and controlled.
The question often arises about the most effective surgical operations and the methods of performing them.
The truth is, almost all bariatric surgeries can have a positive effect on diabetes. From my point of view, the strongest effect on type 2 diabetes in normal and mildly overweight patients is achieved through the „Ileal Transposition”. What does it entail? During the laparoscopic procedure, the surgeon works with the stomach, the duodenum and the small intestine. The upper left part of the stomach is removed, the connection between the stomach and the duodenum is closed, and the first part of the small intestine is exchanged with its distal part. When it comes to the moderately overweight patients, Transit Bipartision surgery is more suitable; and the combination of severe obesity and diabetes should prompt us to propose an operation called Duodenal switch. We will describe this procedure in detail in one of the following videos.
We have already mentioned the mole transposition – Ileal Transposition, a method very well established in the medical world. Now, where do we most often perform the surgeries? How do we know they are effective?
I myself have operated on more than six thousand patients as a means to treat obesity, and more than 35% of them had coexisting type 2 diabetes. Analyzing my own results and the works of other colleagues, it turns out that 75% of patients after surgery are without medication or insulin administration, and their blood sugar levels can be controlled with surgery. In Turkey, Arabia, India and Brazil, the Ileal Transposition and Transit Bipartition have been used very often in the last 15 years, and with very satisfying results. I have studied all these operations myself in the laboratory and clinic. The clinical results have been carefully analysed, and I can only confirm the results propagated by Prof. Celick (Turkey), Prof. Gagner (Canada), Prof. Santoro (Brasil), Prof. Karcz (Germany).