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Metabolic Surgery

Length of Stay in Hospital
3 Days
Length of Stay in the City
7-10 Days
Recovery Duration
2 Weeks
Operation Duration
1-2 Hours
Type of Anesthesia
General Anesthesia

Metabolic surgery, also known as diabetes surgery, includes methods that provide control of both diabetes and obesity at the same time. Metabolic surgery improves insulin efficiency while improving other diseases caused by diabetes. Thus, life expectancy and quality of life increase. 

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Who is A Good Candidate?

Metabolic surgery is not suitable for all types of diabetes. Metabolic surgery has no effect on Type I diabetes patients. In order to benefit from metabolic surgery, the body needs to produce insulin, albeit in a small amount. Type II diabetes patients, who make up the majority of diabetics, are the most suitable candidates for metabolic surgery. Even if the patient has Type II diabetes, the level of insulin in the pancreas should be measured. People who have had Type II diabetes for more than 10 years may have reduced insulin production in their pancreas. C-peptide level needs to be checked with a blood test for this reason.

 

In addition, the following tests must be within the specified ranges:

  • Not being a patient of kidney failure, blindness, and unhealed wounds on the legs due to diabetes,

  • Having a body mass index (BMI) above 35,

  • HbA1c needs to be above 7,

  • C peptide level needs to be within the normal range,

  • Having a high result of the Homeostatic Model Assessment for Insulin Resistance (HOMA-IR).

How to Calculate Body Mass Index?

Body mass index can be calculated by dividing weight in kilograms by the square of height in meters. For example, the body mass index of a person 1.70 m tall and 65 kg in weight is calculated as 65 ÷ (1.70*1.70) = 22.5 kg/m^2.

 

Body mass index in medical classification:

  • Those between 18.5 – 25 kg/m² are in normal weight,

  • Those between 25 – 30 kg/m² are overweight,

  • Those between 30 – 40 kg/m² are obese,

  • Those over 40 kg/m² are called morbidly obese.

Which Tests Are Performed Before Metabolic Surgery (Diabetes Surgery)?

The following tests and examinations are applied to every patient before the surgery;

  • Blood biochemistry tests,

  • Hemogram,

  • Hormone tests,

  • Hepatitis tests,

  • Whole abdominal ultrasound,

  • Gastric endoscopy (with anesthesiologist),

  • ECG (ElectrocardioGraphy-heart graphy),

  • Lung X-ray,

  • Lung breathing test,

  • If needed, effort test and ECO (EchocardioGraphy)

 

After all these tests, necessary examinations are carried out by Anaesthesiology, Internal Medicine, Cardiology, Chest Diseases and Endocrine specialists. As a result of these examinations, first of all, it is checked whether there is another underlying disease that may cause the patient to gain weight. If there is no such disease, the patient is examined in terms of anaesthesia, like every patient who will undergo surgery, and it is checked whether there is an obstacle to the surgery. Relevant specialists make recommendations about the treatments to be applied before the surgery, if necessary. In this way, issues that may occur during and after the surgery are minimized.

How is Diabetes Surgery (Transit Bipartition) Performed?

Due to the developed medical technics, metabolic surgery operations can be performed laparoscopic (close) method, nowadays. This operation, which is usually performed by opening 4 to 6 small incisions, is performed with different methods. The common feature of all surgical techniques; to interfere the stomach and reduce appetite, to restrict food intake and in addition to create shortcuts that will allow food to reach the last part of the small intestine.

 

The aim of operation is to limit food consumption by impairing absorption in the gastric tract. The surgery begins with the limitation of stomach volume. An average of 70% of the stomach volume is rendered dysfunctional for this reason. Part of the stomach that has become dysfunctional is also the part of secretion of a special hormone that increases appetite. The remaining stomach is closed by stapling at the incision points to prevent the risk of leakage.

In the second part of the operation, the intestinal tract is connected to the shrunken "tube stomach". The lower part of the large stomach that remains is connected to a lower part of the intestine as a second route. Thus, two different intestinal tracts are formed, which converge as they approach towards the anus, but whose upper part is quite far from each other.

 

At the end of the operation, stomach is shrunken and connected to the lower small intestine, so the distance to the small intestine is reduced. Thus, even if the patient eats a little more, these foods are excreted without being digested.

Postoperative:

  • The amount of food consumption decreases between 50-80%,

  • On average, 60% of the food consumed moves in the new intestinal tract and 40% moves in the old intestinal tract. Passing food in two different ways accelerates digestion, while at the same time reducing the amount of sugar entering the blood. Thus, the rapid transport of foods that increase insulin secretion to the lower part of the intestine increases the amount of insulin hormone.

 

Complete elimination of diabetes, which is the main purpose of Transit Bipartition surgery, is easily accomplished with this intestinal flow chart.

Advantages of Transit Bipartition Surgery

Transit Bipartition surgery technique has many advantages as it was developed after all other digestive system surgery techniques. When Transit Bipartition surgery is applied to suitable candidates:

  • Although the problems related to vitamin and mineral deficiencies continue for 6-8 months, there is no need to take regular vitamin or mineral supplements afterwards.

  • No part of the digestive system other than the stomach is rendered inactive. This ensures that the long-term result is very close to a healthy person.

  • The hemoglobin value in the blood, which increases after other digestive system surgeries, is very close to normal after Transit Bipartition surgery.

  • Closed surgery method and minimal surgical incisions shorten the hospitalization and recovery times considerably.

 

Although it is difficult to talk about the disadvantages of metabolic surgery in general, it should not be ignored that the patients may tend to gain mild weight after 5-8 years depending on their lifestyles. This problem can be eliminated with diet and exercise programs..

Is It Possible to Prevent Diabetes?

Currently, there is no treatment method that provides acceptable success and completely eliminates the disease for Type I diabetics, who make up less than 10% of diabetics and have congenital absence of insulin. Methods such as pancreatic islet cell transplantation or pancreas transplantation, which produce the insulin hormone, have low success rates. Type II diabetes patients, who make up more than 90% of the patients, had no choice but to use oral medications or insulin injections until recently. However, developments in surgical methods in the last 10 years have made it possible to completely get rid of this disease.

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Is metabolic surgery the exact solution for Type II diabetes?


Type II diabetes patients need lifelong medication, insulin supplementation, diet and exercise. However, most patients do not comply with these rules for many years. Continuous and regular treatment reduces the quality of life for patients. Although metabolic surgery method, which has been largely successful, reveal different results from patient to patient, most patients can completely discontinue insulin supplementation after the surgery. In some patients, although the drug doses used after surgery are greatly reduced, medical treatment should be continued. In these patients, possible diseases can be prevented and blood sugar can be under control with post-operative weight loss.




What should patients pay attention to after metabolic surgery?


Although these operations give effective results in most diabetes patients, they also need to make changes in their lifestyles and eating habits in order to increase the success rate. In this process, which also has psychological effects, it is beneficial to get psychological help as well as dietitians and general surgery specialists.




How long does it take for patients to recover after surgery?


Patients are fed only with liquid foods for 2-3 days after the surgery. Patients who are discharged from the hospital in an average of 4-5 days can return to their work after the first week if they work at an office job. Patients who can fully return to their daily lives from the first month should be under doctor’s control for about 2 years.




Who cannot undergo metabolic surgery?


Some type II patient groups cannot benefit from metabolic surgery operations. Metabolic surgery cannot be applied to those with a body mass index below 30, those whose pancreas cannot secrete enough insulin, those with severe psychiatric diseases and organ function losses due to diabetes.




Is there an age limit for metabolic surgery?


Although there is no exact age limit for metabolic surgery, these surgeries are performed between the ages of 18 and 60.




How many hours does surgery take?


It takes 1.5 hours on average. The duration of operation varies depending on the anesthesia.




When are doctor checks done?


Doctor and dietician controls are made on the 15th day, 1st month, 3rd month, 6th and 12th months after the surgery.




When can you get pregnant?


Adequate nutrition is very important for the nutrition of baby in the womb and the health of mother during pregnancy. Vitamin and mineral deficiencies can be seen as the food intake will be limited after diabetes surgery. Since this process will adversely affect both the mother and the baby, it is appropriate to get pregnant 1 year after the surgery at the earliest.




Can nursing mother have surgery?


Diabetes surgery is not recommended for at least the first 6 months after birth, until the baby is on solid food. Since the carbohydrates, fats, proteins, vitamins, and minerals needed by the baby and the mother during breastfeeding, they should be taken in sufficient amounts. Thus, it is not appropriate for nursing mothers to undergo metabolic surgery. Diabetes surgery can be performed if the baby's need for breast milk decreases, if there is no obstacle in the examinations performed.




How does the operation process work for patients coming from abroad?


If possible, the necessary analyzes and examinations for the surgery are performed on the day of their arrival, if not the next day. As a result of these analyzes and tests, if there is no obstacle to the surgery, surgery is planned for the next day. After the operation, which takes an average of 1-2 hours, patients stay in the hospital for 3 days. The patients stay at the hotel until the last control, which will be held 2 days later, and are sent to their home country after the last control.




When can I do exercise after surgery?


It is okay to start walking immediately after the discharge of bariatric surgeries. After 2 months, the dose and intensity of exercise can be increased gradually. Remember, each patient's recovery process is different than other patients. During the healing process, you should avoid movements that make you feel uncomfortable.




Are vitamins used after surgery?


The use of vitamins after bariatric surgeries is quite important. Especially in the first 6 months, patients should use the necessary vitamins as recommended by their doctors.





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Walk-through: What's next?

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First Contact

From the very first contact, we will explore your situation in-depth and start planning the path to the beauty.

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Doctor Choice

We will connect you with the best doctors in their fields for your special needs.

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Travel
Plan

We will assist you to plan your trip and give you advises on city tours.

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Transport and Transfer

Based on your operation schedule, you will fly to Istanbul on the most convenient date for you. From then on, your transfers and appointments will be arranged by us.

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Operation Day

You will be in right hands to reveal your beauty on the date of the operation.

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Home
coming

When your procedures are done, you will return home to enjoy your new life.