Gastric diversion surgery was first used in bariatric surgery, but after several years of clinical practice, doctors accidentally discovered that this surgery can effectively treat diabetes, thus gastric diversion surgery has brought a new gospel for diabetic patients.
Type 2 diabetes accounts for 85-90% of the total number of diabetics, and its prevalence is increasing year by year, with more than 200 million patients worldwide, and its complications are fatal and disabling, seriously threatening the health and lives of patients. However, all the above-mentioned medical treatments cannot ensure that the patient’s blood sugar returns to normal level and cannot prevent the emergence and further aggravation of various diabetes complications.
In the early 1980s, the medical community unexpectedly discovered that a type of surgery for weight loss could “incidentally” cure type 2 diabetes. The international medical community spared no effort in researching the reasons (mechanism of action) for this unorthodox procedure, and although it was only a bunch of conjectures at that time, the treatment of type 2 diabetes by bariatric surgery such as gastric diversion GBP has shown considerable promise and started to be applied in clinical practice gradually.
I. Characteristics
Diabetes mellitus occurs due to.
1, K cells distributed in the gastrointestinal tract are stimulated by food to secrete insulin resistance factors, causing the body to develop insulin resistance.
2. Islet cells are damaged and apoptotic under the action of insulin resistance factor.
The unique feature of gastric diversion surgery is that it changes the physiological flow of food and is accomplished through steps such as gastric block, gastrointestinal anastomosis, and enteroenteric anastomosis. After the surgery, insulin resistance in the patient’s body is eliminated, and the way food flows through the body after the surgery also promotes insulin secretion in the patient’s body, reduces apoptosis and proliferates islet cells, restores islet function, and cures diabetes.
In addition to the normalization of blood sugar, the patient recovered well from a series of accompanying complications. For example, retinopathy, diabetic nephropathy, diabetic dermatitis, diabetic sexual dysfunction, hypertension, hyperlipidemia, etc. were gradually cured. The occurrence of serious complications has been eliminated, and the occurrence of disabling and fatal situations has been avoided.
Gastric diversion surgery (GBP) is less traumatic, low risk, fast recovery and no recurrence; most of the patients recovered normal blood sugar before discharge after surgery and stopped using hypoglycemic drugs and insulin; a small number of patients have a slightly longer recovery time, which mainly depends on the extent of the patient’s preoperative islet function damage. Patients who are treated early will recover more quickly and completely.
Two, six advantages
1.Cure diabetes, normal blood sugar, patients get rid of lifelong medication, no need to control diet. There are two main reasons for the onset of diabetes: one is insulin resistance. The second is the failure of pancreatic islet function. After gastric diversion surgery, insulin resistance is gone, islet function is restored, and diabetes is gone.
2. Diabetic complications are recovered. While internal medicine cannot reverse the complications that have occurred in patients, after gastric diversion surgery, most patients gradually recover from diabetic complications such as hand and foot numbness, retinopathy, diabetic foot, abnormal urine protein, and hypertension.
3.Avoid the occurrence of disability and fatal conditions caused by diabetes. When diabetes develops to a serious degree, it can pose a serious threat to a person’s life safety. After gastric diversion surgery, blood sugar is normal, complications no longer appear, and the danger of diabetes is gone.
4. Obese patients lose weight and thinner patients gain weight. Gastric diversion surgery can bring some unexpected effects to patients, very thin patients will gain weight after surgery, and very fat patients achieve satisfactory weight loss after surgery.
5.Reduce the economic burden of patients. The relative cost is not high, which is the obvious advantage of gastric diversion surgery. According to the survey, most diabetic patients who have been ill for more than 5 years will have various complications, and the treatment of these complications is very expensive. For diabetic patients, one surgery treatment, complications no longer appear, and the economic burden is reduced.
6.Gastric diversion surgery has low risk and fast recovery after surgery. The surgery is simple and quick, with little trauma, quick recovery and no recurrence, and you can eat in 3 days after the surgery and be discharged in a week. Post-operative diet and nutrition absorption are not affected.
III. Indications
1.Meet the diagnostic criteria of type 2 diabetes.
2, Islet function is in compensatory phase (plasma insulin level > 1/3 of normal value).
3.Age ≤ 65 years old (good health condition can be relaxed appropriately).
IV. Contraindications
1.Advanced diabetes mellitus, islet failure, autoimmune diabetes mellitus (LADA).
2.Serious organic diseases (coronary heart disease, cerebral infarction, renal failure, heart failure, severe hypertension, etc.) cannot tolerate the surgery.
3.Gastrointestinal tract dysfunction, moderate to severe diabetic gastroparesis.
4.Age >65 years old.
V. Pre-operative examination
In addition to the general preoperative routine examination, the following tests should be performed before surgery.
1. Autoimmune diabetes antibody test (LADA test).
2. Insulin endocrine function assessment.
VI. Preoperative preparation Antibody testing
Mainly includes insulin autoantibodies (IAA), islet cell antibodies (ICA), glutamate dehydroxylase antibodies (GAD-Ab), tyrosine phosphatase antibodies (IA-2Ab).
VII. Precautions
1.Stop medication before the test.
2.Fast food and water in the morning of the examination and stop taking medication.
3. Register at the general surgery clinic before 9:00 a.m. and have 3 ml of venous blood drawn and go home to wait for the test results. (The results are usually available in four to five days)
VIII. Side effects
Gastric diversion surgery for diabetes has always been a hot topic in the treatment of diabetes. Surgery to cure diabetes is not only the main talking point for diabetic patients after tea, but also the focus of attention in the medical community. What are the side effects of gastric diversion surgery?
In recent years, Australia, Japan, Sweden, the Netherlands, Italy and other countries have also successfully used the procedure, and nearly 400,000 diabetic patients have been treated with gastric diversion surgery, and no long-term complications have been found. On the contrary, in addition to normal blood glucose, a series of metabolic abnormalities accompanying diabetic patients have been better corrected, and diabetic complications have been significantly improved.
In fact, for the surgery, there is definitely some risk, but we do not need to worry because for the gastric diversion is only a small gastrointestinal diversion surgery so there will be no side effects. The advantage of gastric diversion surgery is not only less trauma, low risk, fast recovery, no recurrence, and most of the patients will reach the stable condition of blood sugar before discharge, and can also be treated without insulin injection or Of course, there are a small number of patients with a slightly longer recovery time, which mainly depends on the degree of preoperative damage to the patient’s pancreatic islet function, and for patients with early detection and treatment of diabetes, their recovery will be faster and more complete.
IX. Suitable people
In fact, gastric diversion surgery is only a minor surgery and its danger index is negligible. It is away from the purpose of changing the physiological flow of food and allowing food to proceed to the intestine without passing through the stomach by cutting off the flow in the stomach.
Gastric diversion surgery is suitable for the treatment of any diabetes, only differentiated in terms of therapeutic effect. After an all-round investigation, it was found that the efficiency of gastric diversion surgery in curing type 2 diabetes is up to 100 percent, and it is also very effective in treating type 1 diabetes.
Gastric diversion surgery is a targeted surgical treatment, so it is not suitable for anyone. For people with advanced diabetes, pancreatic islet failure; people with serious organic diseases that cannot tolerate the surgery; gastrointestinal dysfunction, moderate to severe diabetic gastroparesis; diabetes history greater than 15 years or age greater than 70 years, suffering from serious complications, etc. are all diabetic patients who are rejected by gastric diversion surgery. However, there is no need to worry about this, because we will conduct a comprehensive examination of the patient’s condition before the surgery, and we will only perform the surgery if the examination results are compatible with the surgery of gastric diversion.