Gastric Transit Bipartition (Diabetes Mellitus/Metabolic Surgery)

Transit Bipartition surgery is a metabolic surgical method developed for the treatment of diabetes Type 2 and generates the weight loss of obese patients with BMI higher than 30. It was developed 10 years ago by Dr. Santoro in Brazil and is nowadays widely accepted and applied. The surgery consists of connecting the 1/3 end of the small intestine to the stomach as an alternative pathway. The connected part of the small intestine into the stomach is where the small intestine and large bowel (large intestine) meets. Hence, foods passing through here stimulate small intestine hormones to control diabetes. The surgery is being held laparoscopically under general anaesthesia just like other bariatric surgeries such as Gastric Bypass and Gastric Sleeve surgeries. 

Transit bipartition is a surgery modelling that has been developed to counterbalance the increased consumption of high-glycemic index food. The surgery enhances this balance by consisting of a gastroileal anastomosis in the antrum (lower part of the stomach) after gastric sleeve surgery. 

Who are the ideal candidates?

Any patient with Diabetes Mellitus Type 2 is an ideal candidate for this metabolic surgery. However, although this surgery is a weight loss procedure, an overweight patient with a BMI range in between 30-35 and no medical condition such as any vitamin deficiency and Diabetes should consider Gastric sleeve surgery instead of Gastric Transit Bipartition surgery as a first option. Please contact us for more detailed information and let us choose you which surgery is the best fit for you. 

Meanwhile, having a BMI value over 45 qualifies the patient for Transit Bipartition surgery even though the patient may not have diabetes or any vitamin deficiencies. 

The surgery technique in 3 steps:

The first part of the surgery is performing the Gastric sleeve surgery which consists of removal of the 75% of the stomach and reducing the stomach’s capacity volume down to 25%. The main purpose and motive behind this part are to get rid of the fundus (a part of the stomach) that hosts hunger hormones. Hence, the hunger hormone secretion is eliminated in doing so. 

Second part of the surgery consists of spotting the intersection point of the small intestine and large intestine, then integrating this intersection part directly with the stomach. The motive behind this procedure is to drastically increase the hormone secretion that will help with the digestion of the food intake and absorption of the vitamins, minerals and other nutrients. 

The final part of the surgery is the anastomosis structuring of the duodenum. This is being done to decrease the GIP hormone secretion as duodenum is the host for this secretion. GIP (Glucagon-like-peptide) stimulates insulin secretion. 

Although the surgery sounds like a very complex procedure being explained scientifically, it is a straightforward and algorithmic surgery which acts both as a Diabetics repair and weight loss surgery. 

You are requested to be over 18 and free of any cardiovascular diseases to be operated by this procedure.

A great Bariatric Surgery alternative for patients with anaemia and thalassaemia or low Haemoglobin/iron levels due to various diseases.

The biggest advantage of this surgery is that less than 7% of the patients have blood hemoglobin values below 12 gr/dl (range 10-12 gr/dl).

During post-surgical check-ups of transit bipartition patients, it was observed that long-term iron requirement was not seen in any patients as a post-surgical defect except thalassemia carriers. Hence, it is proven that transit bipartition is the ideal surgery who wishes to carry on with a weight loss surgery but has mild anaemia either as a traitor as a disease. While on the other hand, both Gastric Sleeve and Gastric Bypass patients are meant to have B12 intakes after their surgeries regardless of them having low Haemoglobin levels or not. 

What is more, Vitamin D and vitamin B1 (thiamine) deficiency is a common condition in diabetic and obese diabetic patients who have never undergone any surgical intervention (32-60% and 18-45% respectively). Iron deficiency is reported to be in the range of 8-19% in these patients. The 5-year follow-up of the patients with transit bipartition surgery showed that the need for these vitamins was below 10%.

The longitudinal studies above concluded that Transit Bipartition surgery can easily be applied to patients with various vitamin and mineral deficiency.

Advantages of Transit Bipartition

Low intragastric pressure hence, even lower risk of pressure-associated stomach leakage after the sleeve application.

It is a reversible and revisable operation. 

Due to the low pressure inside the stomach, the long-term application of the gastric sleeve process and the prolonged enlargement of the sleeve stomach process alone.

Endoscopic access to all areas of the small intestine, and thus the elimination of the problems of access to the gallbladder, pancreas and bile ducts, especially in techniques that disable the duodenum.

Continuous food migration and absorption from the entire digestive tract.

Endoscopic access to all parts of the digestive system. E.g. ERCP (Endoscopic Retrograde Cholangio-Pancreatography-which is an examination procedure done by the surgeons to examine your pancreatic and bile ducts) 

No need for vitamin, mineral, iron and calcium supplementation due to the protection of stomach antrum, pylorus and duodenum.