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It is a technique introduced to the medical literature by Brazilian surgeon Sergio Santoro. The Transit Bipartition technique is similar to other techniques, in addition to a sleeve gastrectomy procedure, unlike other procedures, all the ten parts of the small intestine are performed by providing a second outlet to the lower part of the stomach. In this way, the passage of the eaten food from all segments of the small intestine is ensured.
In Transit Bipartition, first of all, 100 cm is counted from the point where the small intestines meet with the large intestines and this part is marked. By counting another 150 cm, the small intestine is cut at 250 cm from the junction of the small intestines with the large intestine. The cut lower end is connected to the stomach. The upper end is connected to the previously marked 100 cm. In this way, direct food entry is provided to the last 250 cm of the small intestines.
The only important point is that approximately 1/3 of the food passes through the duodenum, which is the natural way, and 2/3 passes through the last part of the small intestine thanks to the newly made connection. The biggest advantage of this surgery is that less than 5% of patients need long-term iron only. Since 1/3 of the food passes through the normal digestive tract, more than 95% of patients can continue their lives without the need for any supplements.
The term ileal interposition is the process of replacing the last part of the small intestine with the initial part. This surgery works on the principle of deactivating the hormones that cause insulin resistance and raising the hormone levels that increase insulin sensitivity. Ileal Interposition operation is a surgical treatment method developed for the treatment of Type 2 Diabetes since the beginning. The definition of metabolic syndrome includes Type 2 Diabetes, hypertension, high cholesterol and triglyceride levels, and overweight.
Ileal Interposition surgery is not an obesity surgery as a starting point. It is an operation that aims to treat all health problems within the scope of Metabolic Syndrome, especially Type 2 Diabetes. Therefore, obesity is not among the criteria for ileal interposition surgery.
Ileal Interposition surgery does not cause absorption restriction or malabsorption. Patients with ileal interposition surgery switch to liquid food from the 3rd day after the surgery. Within six months to 1 year, they can survive with a completely free diet and without vitamin or mineral supplements.
Patients who are suitable for surgery usually stop all diabetes, blood pressure and cholesterol medications they use after Ileal Interposition surgery. They are observed in terms of the course of these diseases during the hospitalization period after the surgery. The vast majority of patients are discharged without using any of these drugs. In some of them, until the metabolic effect settles, the drugs are continued in a small and controlled manner in gradually decreasing doses for periods ranging from a few weeks to several months. All of these drugs are discontinued when the measurements return to normal.
The effect of weight loss is not much due to the partially wider tube stomach, so it is beneficial for patients who do not want to lose excess weight after surgery. Since it brings the lower part of the small intestines directly to the stomach and allows the food to pass directly to this area, it disables a part of the upper small intestines, so its metabolic effects and its effect on diabetes are quite high. The operation time is longer. Requires advanced laparoscopic surgery experience and skill. Although it does not cause vitamin and mineral deficiency, it requires blood test and vitamin/mineral level monitoring at regular intervals.