The most widely used and more definitive procedure for metabolic surgery to treat diabetes is gastric bypass (RYGB), which some people call gastric diversion or gastric bypass. So what is gastric bypass surgery? Simply put, gastric bypass surgery is a surgical procedure that changes the structure of the stomach from a single passageway to two passages where food and digestive juices are diverted. Gastric bypass surgery firstly divides the stomach into two parts, the smaller upper part, and the larger lower part, and then cuts off the small intestine, reconnects the stomach and food, and changes the pathway for food to pass through the digestive tract, and reduces food intake and nutrient absorption. Simple steps of gastric bypass Step 1: Trim the stomach, preserving about 30 ml of the gastric pouch below the cardia Step 2: Dissect the proximal jejunum at about 100 cm (A is the end of the distal jejunum, and B is the proximal jejunum) Step 3: Anastomose A to the gastric pouch, and anastomose B to the small bowel at 100 cm from A. The above operations are all carried out laparoscopically, and metabolism is done through 2 small incisions ranging from 0.5 to 2 small incisions of 1.0 cm, and is completed under laparoscopy. The metabolic surgery was performed laparoscopically through two small incisions of 0.5 to 2.0 cm. The operation takes only about 100 minutes, with small scars and almost no pain, and the patient can get out of bed on the first day after the operation and be discharged from the hospital in about 5 days. It is safe (lower risk of surgical complications than laparoscopic cholecystectomy), less invasive, less bleeding, shorter operation time and faster recovery Why is gastric bypass surgery a good treatment for type 2 diabetes and how does it work? Initially, surgeons thought that the mechanism of gastric bypass surgery to treat type 2 diabetes was simply diet control and weight reduction, and it was only after clinical and basic research that it was found that changes in gastrointestinal hormones and intestinal flora played a more important role after surgery, and that changes in gastrointestinal hormones reduced apoptosis of pancreatic islet cells, as well as improved and restored the function and even regeneration of remnant pancreatic islet cells. According to the latest authoritative report published in the New England Journal of Medicine in 2017, 12 years after metabolic surgery, the complete remission rate of type 2 diabetes is still 50%, which is far more than the traditional treatments (diets, medications, herbal treatments, etc.). That is, because after changing the structure of the gastrointestinal tract, it caused a series of reactions. 1, reduces the intake and absorption of food, reduces the excessive stimulation of food to the pancreas, on the basis of insulin does not increase or even reduce, but increase the body’s ability to utilize sugar, so as to achieve sugar reduction and weight loss. 2. Lowering the patient’s body weight, mainly fat reduction, reducing the insulin resistance caused by the fat accumulation of simple obesity. 3. Change the secretion of hormone of intestine-islet axis after reconstruction of gastrointestinal tract, so as to improve the sugar metabolism. 4. Changing the intestinal flora, directly lowering blood sugar. The principle of metabolic surgery for the treatment of diabetes is simply that after the gastrointestinal tract structure is changed, the factors affecting body weight and blood glucose are changed, so that the body weight and blood glucose can be lowered.