Gastric diversion (GBP) surgery – a new surgical treatment for diabetes, by changing the food flow pathway, eliminating islet resistance and changing the living environment of pancreatic tissue to achieve the effect of curing diabetes, currently a few provinces in China armed police hospitals carry out this surgery, the talk about gastric diversion (GBP) surgery has attracted much attention. Gastric Diversion Surgery – Origin of Gastric Diversion (GBP) Surgery Gastric diversion surgery, or GBP surgery, originated in developed countries in Europe and the United States in the 1950s. At that time, many obese patients who were influenced by fashionable aesthetics demanded surgery to lose weight. The surgical procedure was the most primitive form of gastric diversion. The clinical observation of the University of Iowa in the United States found that the condition of type II diabetes in obese patients improved significantly after the surgery and their blood sugar stabilized to normal level, but this phenomenon did not attract attention. It was not until 1998 that the East Carolina University School of Medicine reported the results of a 30-year follow-up study of gastric diversion bariatric surgery in a world-renowned medical journal, once again proving the fact that diabetes improved in obese patients after gastric diversion bariatric surgery, and only then did the academic community pay great attention to it. The International Diabetes Center, in conjunction with experts from many countries, conducted in-depth research on gastric diversion (GBP) surgery for diabetes, and GBP surgery was therefore rapidly applied in clinical practice and gradually improved, so that the main beneficiaries of GBP surgery also shifted from obese patients to type II diabetic patients. After more than 20 years of dedicated research and clinical practice by scholars from many countries around the world, the technique has fully matured. Gastric Diversion Surgery – Gastric Diversion (GBP) Surgery Principle: The principle has been basically clarified from the perspective of molecular biology: the intestinal neuroendocrine theory. Under normal conditions food passes through the stomach, duodenum, jejunum and ileum, and is digested and absorbed. Gastric diversion surgery changes the physiological flow of food through partial gastric block, gastrointestinal anastomosis, and enteroenteric anastomosis without removing any tissue or organ. The postoperative digestive tract is divided into two regions: 1. Food diversion zone: This refers to the distal stomach, duodenum and part of the proximal jejunum. Inside this part of the digestive lumen, there are a large number of K cells distributed on the mucosa. As soon as they are stimulated by food, the K cells secrete a large number of cytokines, which are collectively called insulin resistance factors, causing the body to develop insulin resistance, which is the most initial cause of diabetes formation. If you do a diversion, the upper gastrointestinal tract no longer receives food stimulation, K cells secrete these insulin resistance factors and the body’s insulin resistance phenomenon is weakened, thus removing the initial cause of diabetes. 2. Food flow through area: i.e. proximal stomach, distal jejunum and ileum, this section of digestive tract accepts undigested or incompletely digested food in advance, resulting in increased secretion of some cytokines such as endocrine regulatory peptide (PYY) and GP1. These cytokines have the following common effects: a: directly lowering blood glucose; b: reducing the rate of islet cell apoptosis; c: increasing insulin sensitivity through the “intestine-islet axis”, promoting insulin secretion, reducing islet apoptosis and proliferation, and stimulating islet cell value-added; d: protecting islet cells from glucose toxicity and other inflammation. toxicity and other inflammatory hazards. This way the etiology that causes islet apoptosis is also removed. Gastric diversion surgery – Gastric diversion (GBP) surgery results: The World Health Organization (WHO) published criteria for cure are: blood glucose control of 7.1 mmol/l fasting and 11.1 mmol/l or less 2 hours postprandial without strict dietary restriction and discontinuation of any hypoglycemic medication including insulin. The effectiveness of gastric diversion surgery in treating diabetes is immediate: Gastric diversion (GBP) surgery is easy and quick, with an operation time of more than one hour, and with little trauma, quick recovery and low risk. What’s more, the patient’s blood glucose usually starts to drop until normal within half a month after the surgery. Long-term effectiveness of gastric diversion surgery for diabetes: It has been observed that the procedure has been performed abroad for more than 20 years, and no long-term complications have been found in post-operative patients. The surgery is only performed to reduce the irritation of food to the stomach and duodenum, and the overall digestive function is not changed, so there is no malnutrition or poor diet. On the contrary, the patient has recovered well from a series of complications that accompany the surgery due to normal blood sugar. For example, retinopathy, diabetic nephropathy, diabetic foot, diabetic dermatitis, diabetic sexual dysfunction, hypertension, and hyperlipidemia are gradually healed. The occurrence of serious complications has been eliminated, and the occurrence of disabling and fatal situations has been avoided. Gastric Diversion Surgery – Gastric Diversion (GBP) Surgery Risks: Gastric Diversion (GBP) surgery has a risk factor roughly equivalent to that of other moderate abdominal surgeries, such as intestinal anastomosis. The operation takes more than 1 hour, is less invasive, has a quicker recovery and is associated with lower risks. Gastric Diversion Surgery – Contraindications to Gastrointestinal Diversion (GBP) surgery: 1. advanced diabetes, islet failure, autoimmune diabetes (LADA) 2. serious organic diseases (coronary heart disease, cerebral infarction, renal failure, heart failure, severe hypertension, etc.) who cannot tolerate surgery; 3. gastrointestinal tract dysfunction, moderate to severe diabetic gastroparesis; 4. age > 65 years (not absolute, mainly based on physical general condition and the residual function of the islets).