Non-Diverted Ileal Interposition

30.3%

oranında insan ülkemizde obezite hastalığı ile yaşamaktadır.

49%

oranıyla kötü beslenme obezitenin en önemli nedenidir.

6000+

başarıyla tamamlanmış cerrahi operasyon deneyimi

NON-DIVERTED ILEAL INTERPOSITION

What is Non-Diverted Ileal Interposition surgery?

Non-Diverted Ileal Interposition is one of the surgeries that can be applied among surgical interventions related to obesity. The surgery is performed laparoscopically. After a standart sleeve gastrectomy, the middle and lower parts of the small intestines are changed (the jejunum and ileum are replaced) and reconnected. Although the integrity of the small intestines changed during the procedure, the absorption process of foods is not impaired and therefore elemental vitamin deficiencies are not expected if the patient continues the oral intake. There is no bypassed small intestine and the relocation of the ileal small intestine segment results as insulin resistance to be broken.
NON-DIVERTED ILEAL INTERPOSITION

How is Non-Diverted Ileal Interposition Surgery Performed?

The surgery is performed laparoscopically. The surgery starts with a standart sleeve gastrectomy (limiting the stomach volume to 20-30%), then the middle and lower parts of the small intestines are changed (200 cm of small intestinal segment -jejunum and ileum- are replaced) and reconnected. The fast access of food to the last part of the small intestine earlier (first ileum then jejenum) ensures existing insulin to work more effectively. Insulin enters the circulation earlier and balances the blood glucose level. This stimulation results in the improvement of the disease by increasing the rate and efficiency of insulin secretion from the pancreas.

The operation is completed in 90-120 minutes. The most important factor determining the duration is the person’s weight, anatomy and previous surgeries, if any.

NON-DIVERTED ILEAL INTERPOSITION

What are the advantages of Non-Diverted Ileal Interposition Surgery?

The surgery starts with a standart sleeve gastrectomy. The reduction of the stomach size and volume, allows the feeling of satiety to occur earlier with less food consumption. A balanced diet, calorie restriction, and less food intake would allow the patient to lose weight controllable.

The fundus (upper region) part of the stomach produces a hormone called ghrelin, which is stimulated in cases of hunger and alerts the brain to eat. The removal of the fundus reduces ghrelin production, which facilitates and expedites weight loss further.

The flow direction of the small intestines is not changed, the only thing that is changed is the flow order. Therefore, the absorption pattern of the food taken does not change. What has changed is that hormonal activation, which normally occurs later with food intake, occurs earlier. Since the rate of passage of food to the small intestines is normal, complications such as diarrhea and dumping are not observed.

Its weight loss effectiveness is long, and the rate of reaching the targeted weight and maintaining the achieved weight is at the level of 85-90%.

Non-Diverted Ileal Interposition surgery should be preferred in patients with obesity and severe insulin resistance and in patients who aim to break insulin resistance with weight loss.

Video Başlığı

Unique Experience

More than 10000 Laparoscopic surgery successes and satisfied patient experience

Detailed Assessment

Safe treatment process with detailed pre- and post-operative examination

Postoperative Support

We are with you 24/7 with surgical and dietitian support that lasts for many years after the treatment

Surgery Process

The routine approach is to evaluate the patients in the preoperative period and to take possible precautions by determining the risks. All patients should be examined in detail during the process of planning the surgery. The main purpose is to detect and treat possible deficiencies and diseases before the operation, and, if necessary, postpone the surgery.

The assessments that have to be done for this purpose, are; evaluation of the lung (such as chest X-ray, pulmonary function tests, consultation from a pulmonologist), assessment of the heart (ECG, ECHO, cardiology consultation, and further examinations like stress ECG, Holter, or angiography if necessary), psychiatric evaluations (questioning the history of drug use, substance abuse, presence of psychiatric disease, and psychiatric consultation), surgical tests (abdominopelvic ultrasonography, doppler ultrasonography, history of previous abdominal surgeries), internal medicine (non-surgical) evaluations (existence of other diseases and treatments being used, internal medicine consultation, etc.), endoscopic exploration (visual assessment of the esophagus, stomach, and small intestine with endoscopy), laboratory tests (blood work, assessment of liver functions, kidney functions, and establishing the bleeding time).

The medications used by the patients should also be taken into account (such as blood thinners, antihypertensive and antidiabetic drugs, and psychiatric drugs). During the operation, some drugs should be discontinued or replaced with other medications, and re-continued after the surgery, as soon as possible.

In the presence of additional comorbidities (like previous operations, heart attack, lung infections, neurological and psychiatric diseases, hypertension, diabetes, and obstructive sleep apnea syndrome), the patient should be checked in the relevant department, and the evaluations and suggestions of the specialist there should be taken into account.

The medications used by the patient must be evaluated, and their use, dosage, or discontinuation in pre-and post-operative time should be planned.

High-risk patients must be hospitalized and treated before the operation.

Patients who have undergone surgery are evaluated by the anesthesia team and if allowed, taken up their rooms for further follow-up after waking up. There is no need for the patient to be followed in the intensive care unit after the surg ery (except for special cases such as sleep-apnea). 6 hours after the operation, the patient can start to drink water in a controlled manner, while the patient stands up and takes mini walks. One day after the operation, the patient’s walking frequency is increased and the patient is supported with breathing exercises. Consumption of liquid foods (such as seedless soup, compote) is started in a controlled manner following the gas discharge. The drain is removed during this process. In order to observe the clinical situation and to catch possible complications, the patient stays in the hospital for a total of 3 nights and is discharged on the 4th day.

Before discharge, all details of nutrition are explained to the patient and their relatives, under the control of a dietitian, and the drugs that the patient will use and the points to be considered are explained in detail.

Postoperative diet and nutrition are explained under the control of a dietitian. Questions such as what should be eaten in the early process, at what speed and interval should it be consumed, what should not be eaten are answered.

Patients are given a 1-month diet program to follow. The main purpose here is not to weaken the patient quickly, but to ensure the safe healing of the surgical field and not to endanger the safety of the suture line with excessive-incorrect consumption.

From the first month, nutrition returns to normal in terms of consistency. In order to ensure a healthy life and controlled weight loss, foods that should not be consumed are explained in detail and the patient’s adaptation process and weight loss are monitored monthly.

The drugs that should be used in the first month after the surgery are stomach protectors, multivitamins and pain relievers if needed. These drugs are released in a controlled manner after the first month.

The drugs used in the pre-operative period are started again. In the case of regression of some weakening-related diseases (such as hypertension, hypercholesterolemia), the drugs used are left in a controlled manner in line with the knowledge and recommendation of the relevant physician.

Although every surgical intervention has some complications and risks, there are complications and risks specific to each surgery. What scientifically important is the occurrence and treatability of these complications.

Complications that can be seen in laparoscopic metabolic surgery are; bleeding through surgical incisions, wound problems (such as surgical site infections, and poor wound healing), specific complications (like surgical site bleeding, and leaks after the disruption of the site’s integrity), positional complications of the structural integrity of the stomach (strictures throughout the passage, twisting of the stomach around itself (torsion), etc.), post-surgical complications unrelated to the surgical site (such as lung infections, urinary tract infections, heart problems), long-term complications (weight loss faster or slower than expected, ineffective/inactive weight loss or weight gain, vitamin and mineral deficiencies).

The incidence of these complications ranges from one percent to 1 in 10 thousand to even 1 in 100 thousand. At this point, what’s important is the early diagnosis of preventable complications and the application of appropriate treatment when they occur. Likewise, identification of the causes that increase the risk of complications even before the surgery (such as the presence of other diseases, smoking, alcohol, other factors affecting wound healing, or other diseases that may increase the adverse side effects of anesthesia) and if necessary removing these risk factors first, reduces the prevalence of the complications considerably. Similarly, precautions for postoperative complications can be taken (such as early mobilization, respiratory muscle training, strict aftercare and follow-up, and early initiation of appropriate medical treatment) to ensure the process is completed without any problems.

Another important point in the postoperative period is the early detection and appropriate treatment of undesirable complications. The fact that “Early diagnosis saves lives”, which is always said in diseases such as cancer, is valid for every aspect of medicine, especially in surgical complications. Unfortunately, failure to diagnose a complication at an early stage that can be brought under control with appropriate treatment can cause the situation to worsen and may become uncontrollable and untreatable. Therefore, it is important to inform and check in with the patients at every step and to follow up with the patient closely after the surgery. It should never be forgotten that the experience and knowledge of the surgical team is the most important component in the management of surgical complications.

Frequently Asked Questions

The first criterion to be considered in patients who will be planned for bariatric surgery is body mass index (BMI) and the lower limit is 40. In the presence of obesity and an additional disease (such as diabetes, hypertension, asthma, sleep-apnea), BMI should be over 35.

Other criteria sought additionally in patients who are planned for surgery are to have tried diet and exercise before, to be mentally competent to understand and accept the surgery to be performed, not to have a psychiatric disease, and not to have alcohol-substance addiction.

Non-Diverted Ileal Interposition surgery should be preferred in patients with obesity and severe insulin resistance and in patients who aim to break insulin resistance with weight loss.

In sleeve gastrectomy surgeries, the cutting of the stomach is done with a stapling system called as laparoscopic linear cutter staplers. Even if the staple line is safely closed after the procedure, bleeding may occur along the line. Scientific studies in recent years show that suturing the staple line significantly reduces the risk of bleeding in the early postoperative period. Similarly, it is known that suturing the line reduces the leakage rate. Therefore, we strongly recommend suturing the staple line in order to reduce the risk of surgical complications.
It is known that some diseases related to the loss of excess weight after surgery regress. Bone-joint disorders caused by excess weight gradually decrease and disappear in proportion to the weight lost. Hypertension begins to disappear due to the decrease in excess fluid load, drug dependence gradually decreases in patients using drugs, and drugs are discontinued under cardiology control. Similarly, the existing blood sugar level gradually decreases due to insulin resistance, and the use of existing pills is terminated under internal medicine control.
Post-operative walks are started as soon as possible. After the second week, sports such as brisk walking and swimming can be done. After the first month, weightless exercises can be started (such as pilates). As of the third month, weighted sports can be done easily (such as fitness, weighted exercises).
If the wound sites are closed subcutaneously (aesthetically) after the surgery, there is no need to remove the sutures. In patients whose stitches have to be closed normally, the stitches are removed after 12-15 days.
After the surgery, the existing insulin resistance returns to normal with weight loss and reduction of fat accumulation.

The period with the highest weight loss after surgery is the first month. The reasons for this are a low-calorie diet with liquid foods and the loss of excess fluid in the body, along with normal fat loss. After the balance is achieved, weight loss is parallel to the lost fat. The average weight loss seen in the first month is 5-15 kilograms.

In the following months, the average weight loss is between 1-4 kilograms per month. The increase in weight loss is related to how active the person is and how much exercise they do.

Some patients may experience skin sagging after weight loss surgeries. What determines this is related to how overweight the person is, the presence of sagging before the surgery, and the rate of weight loss. It is recommended that surgeries related to sagging be postponed until after weight loss is complete.
After the post-operative staple line is healed, the stomach may stretch a little, but the stomach does not enlarge.
The weight loss status of the patients after the surgery is followed up on a monthly basis by contacting them. Blood evaluations are made in the 1st, 3rd, 6th, 9th and 12th months.

Surgery is not applied to patients with a body mass index below 30.

Surgery is contraindicated to patients with severe heart failure, uncontrolled cardiovascular disease, end-stage lung disease, cancer or treated for cancer, cirrhosis in the presence of portal hypertension, uncontrolled substance or alcohol abuse, and people with severely impaired intellectual capacity.