The first surgery developed for the treatment of type 2 diabetes with surgery is ileal interposition surgery. As a result of the studies conducted, the incretin effect of hormones secreted from the last part of the small intestine has been noticed.
The basic logic of the ileal interposition surgery has been based on this basis. The goal is for hormones like GLP-1, which are secreted from the last part of the small intestine and effectively control blood sugar, to meet these hormones during the transition from the stomach to the small intestine without allowing the carbohydrates in food, particularly, to rapidly raise blood sugar levels. This is why, in ileal interposition surgery, bringing the last part of the small intestine closer to the stomach by proximalizing it constitutes the most important step of the surgery.
The ileal interposition surgery has been developed for patients with Type 2 diabetes. Unfortunately, patients with Type 1 diabetes are not suitable for this surgery. Patients with type 2 diabetes, whose insulin reserve is sufficient as a result of the tests conducted, are candidates for this surgery regardless of their obesity status.
In ileal interposition surgery, the goal is primarily to quickly empty food from the stomach and deactivate the hormone-active region of the stomach by reducing stomach volume. Then, the ileum is proximalized and food is allowed to meet with insulin-like hormones as soon as possible.
The surgery is performed by using laparoscopic or robotic method. The average surgery time is 2-3 hours in our series. Patients are discharged after being followed up in our service for 3-4 days after the surgery.
Its Advantages
❖ Obesity is not required for ileal interposition surgery. It can be easily applied to patients of all weights.
❖ When ileal interposition surgery can be performed with the closed method, the postoperative recovery period is short.
❖ In the postoperative period, blood sugar control is provided without the need for the insulin injection that the patients typically use.
❖ The surgery provides significant benefit for not only for diabetes but also for other components of the metabolic syndrome.
Its Disadvantages
❖ The surgery is an advanced laparoscopic surgery and it is difficult to perform and the surgery time is longer than other surgeries.
❖ Even if various effects are observed due to digestive system changes in the postoperative period, they can usually be temporarily eliminated with the supplements.
Postoperative Period
In order to regulate the digestive system habits during the postoperative period of about 1 month, the transition from the liquid foods to soup, puree, and finally solid food is done gradually. All this information is explained in detail by our dietitian and our team. Diabetes does not disappear immediately; however, it provides protection from its negative effects from the first days. The settling of the effects of the surgery takes about 6-8 months. After the first year, the diabetes has been taken under control after the 1styear.
