Laparoscopic Duodenojejunal Bypass

Metabolic Surgery for Diabetes

Diabetes mellitus is a chronic relentless disease resulting from either decreased insulin production, or increased resistance to its action in the body.

The prevalence of diabetes has reached epidemic proportions globally.

Diabetes is the major cause of premature illness and death worldwide. Non-communicable diseases including diabetes account for 60% of all deaths globally. This evil disease results in cardiac and stroke-related deaths, kidney failure, blindness, and two third of preventable amputations . In cardiac surgery, having diabetes is more risky than a previous heart attack.

The mainstay in the treatment of Diabetes is good diet control, drugs – Both oral and insulin injections and control of weight . However, despite good success in short term, most patients are unable to achieve long term blood sugar control with drugs alone and large majority of them need insulin injections ; also, the end organ damage, that is damage to the Heart, Kidneys, Brain, Eyes etc continues as controlling blood sugar alone does not stop the cascade of end organ damage or microangiopathy.

Metabolic Surgery for Diabetes is the only proven tool for complete resolution of Diabetes in about 80% patients suffering from Type-II Diabetes. The remaining 20% also,do benefit in term of reduction of the drugs or correction with only oral drugs instead of insulin injections.

Surgery for Diabetes is a safe option for many. There are strict criteria to follow to choose the patients, and in the selected ones a complete reversal can be expected in about 80%. International Diabetes Federation (IDF) is the largest governing body in the world for Diabetes and related diseases and it endorses this surgery. Other renowned organisations that favour the Surgery for Diabetes are- American Heart Association and The American Diabetes Association.

This procedure is done laparoscopically and the patient is usually fit to go back home in a day or two. The procedure for diabetes is a bit different from the classical weight loss surgeries as it is not done for weightloss but for its metabolic effect on the body. The surgery is independent of the BMI of the patient. Ileal interposition and duodenal – jejunal bypass aim at correcting the hormonal imbalance in these diabetics with a good controll achieved in more than 80% patients. The mechanism of action is largely related to bypassing the food to lower part of the small intestines and release of certain gut hormones that act on the pancreas, on Insulin, its action on the tissues and also end organs. A few dietary restrictions are to be followed for initial few weeks, post which one can lead a normal and healthy life without being dependent on insulin shots!!

Having said that , this surgery should be done only in specialied centers where this is done routinely by adequately trained and expert surgeons . Thus it gives a permanent cure to this traditionally regarded as a progressive, unrelenting disease called Diabetes.

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