What is ileal interposition?

What is ileal interposition?

Ileal interposition is a special operation developed for treatment of diabetes.  It does not cause any absorption failure in opposite with other metabolic surgical methods.  Therefore, ileal interposition operation is applied on diabetic patients who are not obese in particular.  It provides non-obese people return to normal weight by loosing a couple of pounds.  It actually removes tissue resistance against insulin hormone which causes diabetes.  It increases insulin production capacity of pancreas.

Is Pancreas Operated in Ileal Interposition?

Pancreas is never intervened in ileal interposition operation.  Ileal interposition is associated with stomach and small intestines only.  None of organs are cut and removed except removal of small part of stomach.  Almost all length of small intestine is preserved.  Small intestines perform their functions by preserving their normal functions.  Triggering of hunger by stomach is prevented.  Each step performed in ileal interposition has a hormonal purpose.  In other words, different hormones are stimulated or suppressed in each stage of ileal interposition operation and all findings of diabetes are eliminated by supporting insulin effect.

What is the difference of ileal interposition from other surgeries?

The actual important point in ileal interposition operation is that no procedure that will cause absorption defect (malabsrotpion) is performed.  A section taken from last part of small intestine is connected into anterior part of first section of small intestine in ileal interposition operation.  So, at most 70 to 80 cm small intestine is separated from food in total. This length is same with other lengths used in stomach operations performed by different reasons.  Ileal interposition operation does not show this effect by restriction of absorption (or malabsorption).  The cause of effect of ileal interposition is providing contact of undigested food with the last part of the small intestine earlier.  Foods contact with ileum and cause fullness sense to be sent to the brain by hormonal stimulus in patients who had ileal interposition.  We call this “neuro-endocrine break”.

Ileal Interposition and Neuroendocrine Break

Ileal interposition is a digestive system surgery.  Outer part of stomach is removed and stomach is reduced.  So, secretion of hunger hormone called Ghrelin secreted from the removed part decreases.  Connection of duedonum with stomach is closed after pylorus muscle.  So, foods do not contact with duedonum.  GIP (Gastrointestinal Polypeptide) strength increases and re-inforce insulin effect.  Last part of small intestine is connected behind pylorus.  Foods progress into ileum early after they are taken and stimulate L-cells.  L-cells exist in ileum and secrete GLP-1 (Glucagone-like Polypeptide).  GLP-1 decreases, even eliminates insulin resistance in muscles.  Furthermore, it stimulates beta cells producing insulin in pancreas.  It increases number of cells and insulin producing capacities.  It reduces tissue resistance of insulin.  The body may produce insulin better and controls blood glucose with less insulin easily.  In other words, it rapidly and strongly fixes blood glucose metabolism.  It eliminates high glucose stress on the body.  Defects appeared in blood fats due to high glucose are also fixed with these effects.  When blood fats start to recover, important accompanying diseases dependent to those such as atherosclerosis and hypertension also recover rapidly.  Because of all these complementary effects, ileal interposition shows highly positive effects on all components of metabolic syndrome.

Ileal Interposition and Obesity   

Ileal interposition is superior to all methods in treatment of morbid obesity.  Because it does not cause any malabsorption although it is an operation which has the highest control strength as well as weight loss effect.  Because it is not a malabsorptive bypass surgery. It shows its effect by hormonal breaking. Although ileal interposition is a method developed for treatment of Type 2 Diabetes, it is a revolutionary operation which will change all algorhythms because it has long term control in obesity treatment and does not cause vitamin-mineral deficiency.

Ileal Interposition and Malabsorption

All morbid obesity operations including bypass cause malabsorption without no exception.  These operations include Mini-Gastric Bypass, R-Y Gastric Bypass, Biliopancreatic Diversion-BPD, BPD- Duodenal Switch and Duodejejunal Bypass-DJB.  Severe absorption defects appear after these operations.  These patients live with vitamin and mineral deficiencies for lifetime.  All of these patients have to use supportive drugs including iron, B12 and calcium.

Ileal interposition is not a bypass, a replacement procedure in small intestine.  So, almost all small intestine remains same except skipping a short section of small intestine required for new connection.  No significant decrease appear in small intestine distance where absorption occurs.  Therefore, patients completely quit very simple vitamin pills that they take after 6 to 8 months.  Majority of patients do not need drug supplementation anymore.

No malabsorption occurs after ileal interposition surgery!

May ileal interposition be applied to every metabolic syndrome patient with obesity?

Ileal interposition is the most difficult surgery for surgical technique.  It is performed completely laparoscopically.  We may easily apply ileal interposition to patients whose Body Mass Index – BMI is lower than 50 kg/m2 in a single session.  However, we prefer to apply the surgery in two stages because of anesthesia duration and technical difficulties brought by internal organ lipoidosis.  We perform a standard sleeve gastrectomy (Gastric Tube) to these patients first.  BMI level reduced from 50 kg/m2, even below 40 kg/m2 within a year.  Then, we apply ileal interposition to these patients for permanent weight loss effect and metabolic regulation.