Metabolic Surgery

What is Metabolic Surgery?

Although metabolic surgery is popularly known as sugar and diabetes surgery, it is mainly used for the treatment of diseases such as type 2 diabetes, obesity, hypertension and high cholesterol. Failure to treat these metabolic syndrome diseases may lead to a decrease in quality of life as well as serious life-threatening problems.

Since metabolic diseases are treated using surgical methods, the method is called metabolic surgery. As a result of the developments in recent years, the success rate of metabolic surgery procedures has gradually increased. It may be used as a rapid treatment method, especially for diseases diagnosed early.

Metabolic surgery, which means the use of bariatric surgery types in the treatment of metabolic syndromes, especially type 2 diabetes, is not limited to a single method. There are many different surgical procedures that can be performed in this context. The methods to be applied within the scope of metabolic surgery are determined on a patient-specific basis, depending on the problem to be treated and how suitable the method is.

The main goal of metabolic surgery procedures is to ensure that the nutrients taken into the body meet the bile and pancreatic fluids later. Thus, the body begins to secrete substances that activate the insulin production of the pancreas, and insulin secretion rises and increases automatically.

What are the Metabolic Surgery Methods?

Although different procedures can be performed within the scope of metabolic surgery, these procedures are performed by the laparoscopic method, also called closed surgery. In the laparoscopic method, no incision is made to the patient. Instead, four or five holes are entered and the surgery is performed.

Depending on the method applied, the operation is completed in 1 to 3 hours. Depending on the method, the patient may need to stay in the hospital for 4 or 5 days. Among the methods to be applied within the scope of metabolic surgery; Sleeve gastrectomy, duodenal switch variants, mini gastric bypass, transit bipartition, ileal transposition variants can be listed. Some of these procedures restrict eating, while others disrupt intestinal absorption.

How to Decide on Metabolic Surgery?

The decision for metabolic surgery is made after detailed evaluations for each patient. In order to perform metabolic surgery procedures, the patient’s body mass index must be over 40, and if the body mass index is over 30, blood sugar must not be under control despite the treatment. In addition, the number of years the patient has had diabetes, insulin use and Hemoglobin A1C level are evaluated.

In order for patients to benefit optimally from metabolic surgery procedures, pancreatic insulin secretion must continue. In addition to determining the status of the pancreas with tests performed before surgery, the patient’s obesity status should also be evaluated. More successful results can be achieved with metabolic surgery procedures in people whose diabetes has just begun and who do not need insulin treatment, but instead use low doses of medication.

Why is Metabolic Surgery Performed?

Just as all surgical procedures have risks, metabolic surgery operations also have risks. On the other hand, when the risks of metabolic surgery operations are compared with the risks of the diseases targeted to be treated, it can be seen that the risk of the surgical procedure is less. In order to reduce the risks that surgery may bring, the patient must be evaluated correctly and the surgery must be performed by a team that is expert and experienced in this field.

It is important to carry out every step correctly, from the evaluation of the patient to the performance of the surgery and post-operative checks, in order to eliminate the risks associated with the surgery and obtain optimum benefit from the surgery.

On the other hand, it should not be forgotten that metabolic surgery is not suitable for all types of diabetes. Patients with type 1 diabetes cannot benefit from metabolic surgery. In order for metabolic surgery to be beneficial, the patient’s body must be secreting a little insulin. Since insulin secretion is not possible in type 1 diabetes, different treatment methods are used.

Type 2 diabetic patients, who constitute the majority of diabetics, are considered to be the most suitable candidates for metabolic surgery. However, despite having type 2 diabetes, there is a risk of decreased pancreatic insulin production in those who have had diabetes for more than 10 years. Therefore, before deciding on surgery in type 2 diabetic patients, the insulin level in the pancreas should be measured. In this context, the level of C-peptide, which is the precursor of insulin in the pancreas, is checked with a blood test.

One of the important factors in choosing a patient to undergo metabolic surgery is the patient’s body mass index. Metabolic surgery can be applied to patients with a body mass index of 35 and above. Metabolic surgery procedure may also be applied to patients who cannot benefit from medical type 2 diabetes treatment and whose body mass index is over 30.

Are There Risks of Metabolic Surgery?

Metabolic surgery, like other surgical procedures, carries some risks. As with all surgical procedures, there are risks associated with bleeding, infection and anesthesia in metabolic surgery operations. Additionally, patients should pay attention to their nutrition after metabolic surgery procedures. Otherwise, there may be a risk of developing various nutritional problems such as vitamin and mineral deficiencies.

There are some complications that may occur in the early and late periods after metabolic surgery operations. Although these complications are not life-threatening, their occurrence rates are extremely low. Among the possible problems that may be encountered with metabolic surgery: Stapler line leakage, lung infection, need for respiratory support after surgery, intestinal obstruction, clot formation in the leg veins and early urination difficulty.

On the other hand, encountering all these problems is rare. Moreover, if they are detected early, successful treatment can be applied. In this context, it can be stated that the risks of metabolic surgery are extremely low compared to the risks caused by diabetes.

What Are the Results of Metabolic Surgery?

After metabolic surgery procedures, diabetes improves in 95% of patients. HbA1c level drops below 6 in more than 65% of patients and remains between 6 and 7 in 30%. It may be possible for patients to completely stop using insulin and tablets.

There are several factors that affect recovery from type 2 diabetes after metabolic surgery. Among these factors, the duration of diabetes of the patient undergoing metabolic surgery, the insulin need before the surgery, the age of the patient and the amount of insulin secretion of the body come first.

What is the Effect of Metabolic Surgery on Large Vessels?

Diabetes causes narrowing of the walls of the vessels in various parts of the body over time. As a result of the decrease in cardiac flow to different organs such as the heart, legs, brain and, in men, the penis, heart attack, leg ulcers, stroke, gangrene and erectile dysfunction may occur. If surgery is performed before the problems in question develop, it may be possible to get rid of complications or delay the occurrence of complications for years. If the patient has these problems, the worsening of the condition can be stopped and blood flow and related problems can be improved.

What are the Microvascular Effects of Metabolic Surgery?

Increases in blood sugar levels and fluctuations in blood sugar may cause deterioration in the functions of some organs and tissues other than the kidneys, eyes and retina. As a result, serious problems may occur, including kidney failure and vision loss. Thanks to metabolic surgery, it is possible to normalize blood sugar levels and prevent fluctuations. If these problems have not yet occurred during the surgery, their occurrence may be prevented and delayed for years.

How Much Does Metabolic Surgery Cost?

It is known that metabolic surgery and bariatric surgery are relatively expensive surgeries. The source of costs is usually the use of special materials such as staplers during surgery. Metabolic surgery prices are affected by various factors such as the experience of the specialist performing the surgery and the price policy of the clinic where the surgery is performed. Therefore, it is not possible to talk about a fixed price for metabolic surgery.

Is Metabolic Surgery Effective in Diabetes Treatment?

Type 2 diabetes is a health problem characterized by increased blood sugar because the pancreas cannot secrete enough insulin. Factors such as genetic predisposition, obesity and physical inactivity may trigger the formation of type 2 diabetes.

High blood sugar in type 2 diabetic patients may result from insulin secretion deficiency and insulin resistance. The situation where there is enough insulin in the blood but the insulin cannot show its effect is called insulin resistance. If insulin resistance is not treated; It can cause an increase in blood sugar or sugar levels, which can negatively affect various organs and tissues, including the heart, kidneys and eyes.

However, it cannot be said that all type 2 diabetes patients are candidates for surgical treatment. Some tests are performed to determine whether patients will benefit from surgical treatment. According to the results of the tests, it is determined whether insulin secretion from the patient’s pancreas continues. According to the results, if it is deemed appropriate to treat diabetes with surgery, surgery planning begins. At this stage, factors such as how long the patient has had diabetes, whether he is obese, his age and the C-peptide level in the blood are evaluated.

Type 2 diabetes accounts for approximately 95% of all cases of diabetes. It can be defined as a chronic metabolic disorder that occurs when the body cannot produce enough insulin or cannot use the insulin it produces effectively. Treatment methods such as changing lifestyle habits and using anti-diabetes medications can be used for type 2 diabetes. Metabolic surgery stands out as a permanent treatment for diabetes. Metabolic surgery allows blood sugar levels to be kept under control. In this way, the aim is to continue the patient’s life without medication or with less dependence on medications.

Metabolic surgery, unlike obesity surgery, focuses on controlling not only excess weight but also metabolic diseases. By using different methods within the scope of metabolic surgery, the patient’s quality of daily life can be improved, and the psychological negativities experienced due to their pain and disease can be eliminated.

Especially in morbidly obese patients, blood sugar levels can be normalized without medication and diabetes can be alleviated. By significantly lowering the blood sugar level, the disease can be controlled with fewer medications. In addition, metabolic disorders such as hyperlipidemia, hypertension and sleep apnea can be improved.

However, before resorting to metabolic surgery, type 2 diabetic patients need to follow a diet and exercise. In addition to exercise and diet, medication may also be used if the doctor deems it necessary. If the medications used, exercise and diet are causing negative effects on the person’s life instead of helping the disease get better, it may be beneficial to resort to metabolic surgery procedures.

In this regard, it is important to learn patients’ health goals and ensure that they have detailed information about existing procedures. Then, detailed examinations and evaluations must be carried out on an individual basis and a decision must be made as to whether the patient is suitable for metabolic surgery procedures. If the patient is found suitable for metabolic surgery, the method to be applied is determined and the process is planned specifically for the patient. Successful results can be achieved by applying these steps by an expert and experienced doctor and his team.