Permanent diabetic surgery
This procedure can be done for persons who have Type 2 Diabetes, who are on oral drugs & or insulin. This procedure will be useful if the C-Peptide blood test is more than one. The HBA1c test gives a person an indication of poor control if level is more than eight. Complications of diabetes will be arrested unless the organ damage has already progressed to a point of no return. So, this surgery can completely control diabetes, arrest the metabolic syndrome of body organ deterioration, thus avoiding future diabetic complications. High blood pressure and high cholesterol /triglycerides are also completely controlled or greatly improved and body loses excess weight which is good for overall longevity with good health.
This switch operation causes a surge in the body’s insulin soon after taking food thus controlling post-prandial sugar. It also increases the insulin sensitivity of target cells so that fasting sugar levels dependent on liver are better controlled. Thus this operation controls sugar in the most physiological way by enhancing the effect of body insulin. The progressive destruction of insulin-secreting B-cells in pancreas is arrested. This is a surgery done on the intestinal tract, and not on the pancreas. The procedure is done by key-hole surgery; is practically blood-less; using modern state-of-the-art Stapling Devices and blood vessel self-sealing devices; needs about five days of stay in the hospital for observation, especially of the dropping blood sugar levels .
Diabetes being a medical disease, it was traditionally treated by diet and exercise with mild oral medicines. When this progressed, more drugs were added to control blood sugars; when this went on increasing, insulin injections were added.Diabetes is the cause of cardiac problems and kidney failure in many patients; it is a killer disease with epidemic proportions in the world. The disease keeps on progressing in most people with on-going complications on many organs in the body. It is associated with high cholesterol levels, high blood pressure, fatty liver disease, obesity and polycystic ovary disease causing the Metabolic Syndrome.
METABOLIC SURGERY FOR DIABETES
“Studies have shown that metabolic surgery is superior to medical management in patients suffering from Type 2diabetes and Obesity (especially if BMI is ≥ 30 kg/m2).”
In metabolic surgery we remove part of stomach (Sleeve Gastrectomy) and rearrange small bowel. This leads to changes in several gut hormones that control release of insulin and its action. It cures as a result of several factors, some of them are increased incretins, reduced anti incretins, reduced ghrelin, increased action of leptin, rapid emptying of stomach, calorie restriction and weight loss.
Sleeve gastrectomy component of metabolic surgery results in calorie restriction and weight loss. Weight loss has positive impact on maintaining normal glucose levels in blood. Weight loss increases insulin action, reduces damage to beta cells in pancreas. If surgery is performed on normal weight diabetic patients, weight loss is not much or will not be there.
These can be performed both in obese as well as non obese diabetics
In this type of surgery, up to 80 percent of left side of the stomach is removed and the first part of the duodenum is disconnected using linear cutter stapler. A significant segment of the ileum is isolated by dividing the ileum proximal to the Junction of the small and large bowels. Bowel continuity is restored by joining the remaining ends of the ileum and all the mesenteric gaps are closed. In this operation Ghrelin hormone – the hormone responsible for hunger production is reduced, as fundus of the stomach is removed.
LAPAROSCOPIC SLEEVE GASTRECTOMY WITH DUODENOJEJUNAL BYPASS (SG – DJB)
It is actually a combination of Sleeve Gastrectomy with roux – en – y gastric bypass.
In this type of surgery, up to 80 percent of left side of the stomach is removed and the first part of the duodenum is disconnected using linear cutter stapler. Jejunum is divided distal to duodenojejunal flexure and Bowel continuity is restored and all the mesenteric gaps are closed.
Any patient suffering from type 2 diabetes who is fit, aged between 18 to 65 years, duration of diabetes should be > 3 years and < 20 years.
RESULTS OF THE SURGERY
In obese people, because of narrow stomach tube, food intake is restricted, which leads to calorie restriction and weight loss. All these factors contribute to the resolution of diabetes in more than 95 percent of type 2diabetic patients.
In more than 65% patients HbA1C becomes < 6% and in 30% of patients HbA1C level between 6 and 7 % is achieved. Patients are off insulin and tablets.