When I learn that “type 2 diabetes can be treated surgically”, many patients are eager to ask me for advice. However, not all sugar patients are suitable for surgery.
First, let’s understand the relationship between obesity and diabetes
Many obese patients are born with the feeling that they are fat and therefore deserve to have this weight. Although obesity is not a disease, excessive weight can bring many other diseases to patients.
Such as: hypertension, hyperlipidemia, hyperglycemia, diabetes, coronary heart disease, arthritis, sleep apnea syndrome, and also obesity can affect polycystic ovary syndrome, etc., a variety of metabolic diseases.
Because obesity will reduce the efficiency of insulin, but also need to maintain stable blood sugar in the body, so it will make the body secrete more insulin, increasing the burden on the pancreas. Just like overloading a car, long-term overload of the pancreas can cause irreversible damage.
Then, to introduce the surgery again.
The world-renowned Cleveland Medical Center named surgery for diabetes as one of the “Top 10 Medical Innovations” that year in 2013 and again in 2015 as one of the “Top 10 Medical Innovations of the Last Decade”.
1. Sleeve Gastrectomy
By removing a portion of the stomach, the volume of the stomach is reduced, controlling the patient’s food intake, adjusting the microbiota in the intestine, down-regulating leptin secretion, and reducing the patient’s desire to eat. Ultimately, it reduces body weight, reduces insulin resistance, and allows blood sugar to return to normal.
2. Gastric bypass surgery
This surgery modifies the structure of the stomach, and most scholars believe that its mechanism is to control food intake while reducing absorption in the small intestine, in addition to promoting the secretion of hormones such as glucagon-like peptide-1 (GLP-1). The latter stimulates islet secretion and regeneration, thus making this surgical procedure more effective in improving type 2 diabetes.
Some studies have found that surgery can result in complete remission in 70% to 80% of cases of type 2 diabetes mellitus that meet the indications for surgery.
Complete remission here is strictly defined, which means that no glucose-lowering medication is needed after surgery, and blood glucose can be controlled by diet and exercise alone, with glycosylated hemoglobin <6.5%, fasting blood glucose <5.6 mmol/L, and 2-hour postprandial blood glucose <7.8 mmol/L, and needs to be maintained for more than 1 year.
There are strict criteria for surgery!
Surgery has strict indications for surgery, and it is only suitable for type 2 diabetes caused by obesity. The Chinese Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes published in November 2014
The Chinese Guidelines for the Surgical Treatment of Obesity and Type 2 Diabetes, published in November 2014, have strict requirements regarding the patient’s age, body mass index, islet function, and the choice of surgical approach.
Age: Patients with diabetes who are not fully developed or over 65 years of age cannot undergo surgery.
Body mass index (BMI) and islet function: Body mass index, also called body mass index, is a medical indicator used to define “obesity” and is an important reference indicator for diabetic surgery.
The islet function is relatively good: Generally, the BMI of this group is greater than 32.5, and the blood glucose is too high only because of insulin resistance due to high body weight. In these patients, blood glucose can be normalized by reducing weight. If these patients need to be treated surgically, sleeve gastrectomy will be used.
Islet beta cell function greater than 1/2 of normal: Since the damage to the pancreatic islets is not very severe, the patient may lose weight. If the BMI is greater than 27.5 it is possible to control blood sugar through gastric bypass surgery. Some patients can be in complete remission of diabetes.
Islet beta-cell function less than 1/2 of normal: Due to the severe damage to the pancreatic islet function, the patient will lose a lot of weight or lose weight. Such patients cannot control their blood sugar by their own islet function, so they are recommended to be treated conservatively. Blood sugar is controlled by taking medication or (and) insulin injections.
The effect of this procedure needs to be supported by the patient’s pancreatic islet function. If the pancreas has no “self-care ability” at all, there is no point in surgery. This is because only by strictly controlling the indications for surgery can the patient get a good treatment result. In the eyes of doctors, surgery is aimed at improving and enhancing the quality of life. If the evaluation predicts that the patient will not achieve the expected results, such surgery may as well not be done.
How to calculate the BMI?
The BMI is calculated to be greater than 27.5 to be suitable for surgery.
Surgery needs to be performed with caution and minimally invasive surgery is recommended.
Bariatric and diabetic surgery is a benign disease surgery. Under the premise of ensuring the surgical effect and safety, whether the wound is aesthetically pleasing or not also becomes another important requirement and assessment index for patients and operators.
Minimally invasive surgery also varies
The traditional five-hole laparoscopic surgery can leave a mark on the scarred patient, and some people say they look like “honeycomb coal”. As the technology has matured, reducing the incision has become a major sign of progress in this type of surgery.
Through our team’s tireless efforts, we have reduced the traditional laparoscopic five-hole surgical approach to four-hole, three-hole, two-hole and even single-hole surgeries. The single-port procedure is the choice to enter through the navel, which is the person’s natural scar and appears to have become a true “zero” scar in appearance. A patient once jokingly said that the surgical scar is like having a double eyelid done to the navel.
So many surgical instruments
Due to the large number of surgical instruments, single-hole minimally invasive surgery is extremely difficult to perform, so the clinical skills of the surgeon are very strict, and patients need to be careful when selecting a hospital and surgeon.
This is “double eyelid”
Don’t neglect post-operative recovery
In 2015, the average life expectancy in China was 74 years for men and 77 years for women (including the less developed areas with medical conditions), so it is not enough to rely on one surgery alone for a long life.