Innovative & Effective Surgical Technique

The Illeal Transposition

Diabetes Mellitus (DM 2) is a worldwide epidemic which is on the rise without much cure and associated with a number of short and long term complications resulting in devastating late complications and reduced life expectancy. DM2 is  a common cause of morbidity and mortality around the world. The global prevalence of diabetes among adults over 18 years of age has risen from 4.7 per cent in 1980 to 8.5 per cent in 2014. And has been seen rising more rapidly in middle and low income countries.

Diabetes is a major cause of blindness, kidney failure, heart attacks, stroke and lower limb amputation^. Retinopathy is a major cause of morbidity in patients with diabetes mellitus. The incidence of blindness, for example, is 25 times higher in diabetic patients with diabetes than in non-diabetic people.

Graduating from JNMC Belgaum, Dr. Abhay Agarwal  did his masters( Surgery) from Mumbai and  his super specialisation in Laparoscopic Surgery from University of Bordeaux, France.Mastering  the art of Laparoscopy from his illustrious father, Dr JB Agrawal, who is the first and with the highest number of Laparoscopic Gall bladder surgeries to his credit in India.he acquired further specialization in Bariatric Surgery (or Obesity Surgery) which is considered as the mother of all Laparoscopic procedures from France, Austria and USA.Dr Agrawal runs the Dept of Bariatric surgery at the Asian Heart Institute, Mumbai.

In a one-on-one he illuminates the efficacy of Ileal transposition in treating Type2 Diabetes.

By the year 2025, India will be home to more than 80 million diabetics and most of these will be Type-2 Diabetics. A disaster of this kind can be avoided if measures are taken earlier and more awareness of the problem and its solution is created amongst diabetics..British researchers in a just released survey found that people from South Asia, especially India, are prone to developing Type 2 diabetes caused by high levels of obesity and insulin resistance

 The World Health Organization (WHO) has reported that by 2030, the prevalence of  T2DM  (Type 2 Diabetes Mellitus) will increase to 336 million . Considering the global health crisis of diabetes and obesity in this era and the need for an effective treatment of patients, surgery can be proposed in addition to drug therapy .

If all complications of DM were combined, individuals with intensive diabetes management would experience 15.3 more years of life without significant micro vascular or neurologic complications of DM, compared to individuals who received standard therapy. This translates into an additional 5.1 years of life expectancy for individuals in the intensive diabetes management group.

Eighty per cent of patients with DM 2 are obese or overweight, and weight reduction is one of the most efficient ways to achieve control over this illness. However, it is difficult to achieve smooth normal blood sugar level readings with just the conventional treatments comprising of diet, exercise, oral tablets and insulin. On the other hand, impressive improvement in diabetic status of patients undergoing bariatric and metabolic surgery has stimulated interest in surgery as a potential cure for type 2 diabetes.

The biggest recent advancement in the medical world is Control of Diabetes (Type 2) by Laparoscopic (Key-hole) Surgical procedure -Ileal Transposition Surgery (small intestinal switch) for control and finally cure of diabetes

THE ILEAL TRANSPOSITION

Research has indicated that there are some intestinal hormones which have a great effect on the pancreas and insulin secretion, especially in response to food intake. A long segment of ilium (ending portion of small intestine) is shifted to the upper small intestinal area, where food particles will reach immediately after the meal. This causes an immediate secretion of a ‘good’ hormone, which spurs the pancreas to secrete  Insulin, to immediately control blood sugar. If there is no intake of food, this will not happen, so there is no danger of low blood sugar (hypoglycemia). 

WHO IS ELIGIBLE FOR ILEAL TRANSPOSITION:

It is evident that in spite of  best medical practice, anyone with Type-2 diabetes is at risk as the disease keeps progressing and the patient ends up with some end-organ complications, especially kidney failure, heart attacks, or retinal eye problems. However, once the patient undergoes the Ileal Transposition surgery, he is as good as normal
The surgery is performed only after taking a detailed history to make sure that the diabetes is of Type-2 and he is suitable to go under the knife. Strong genetic and hereditary factors; number of years with diabetes, number and kind of medicines  being taken is all taken into consideration. In addition, selective blood tests’ which indicates the status of the pancreas is also taken into account

It was originally thought that the control of diabetes was secondary to the resultant weight loss; however more recently, it has been noted that insulin impairment is reversed merely days after a metabolic procedure and therefore could not be solely due to the weight loss

This operation is an ideal  surgical cure of diabetes in non-morbidly obese patients also, as there is no mal absorptive element leading to the weight loss. Patients can stop all medicines within few months, at times even within two to four weeks post the surgery. Good improvements are seen in their Triglycerides, cholesterol, kidney function and leg pains thus proving this to be a true metabolic surgery.

Since there is no loss of intestinal length and no diversion of food, there are no long-term side-effects and no nutritional deficiency. The only life style change required is that, patients need to consume smaller portions of food at one time to enjoy a disease- free, longer and healthier life.

The Ileal Transposition  vs Bariatric surgery

Non-obese patients-In Type 2 diabetic patients with normal BMI, conventional bariatric surgery would be inappropriate, as it would lead to a significant undesirable weight loss. In such patients ileal transposition is the future.

Despite the significant link between obesity and Type 2 Diabetes, 20 per cent  of patients with Type 2 Diabetes are not obese and some of these patients are unable to achieve adequate control of their blood glucose despite dietary and pharmacological treatment.  In these non-obese patients, DM 2 is still associated with significant morbidity such as blindness, renal insufficiency, neuropathies, amputations, and cardiovascular disease and reduced life expectancy.  While a significant body of research exist showing that bariatric surgery can reverse Type 2 Diabetes in obese individuals, there is limited but promising evidence of its efficacy in the non-morbidly obese population.

Obese Patients-Laparoscopic sleeve gastrectomy (LSG), a restrictive bariatric operation is added to Ileal transposition to induce weight loss in moderately obese diabetic patients. Diabetes is resolved in all the diabetic patients, hypertension is resolved in 92.9 per cent and improved in the remaining patients.

 As per the International Diabetes Federation (IDF) educational program it is informed that every 10 seconds, 2 people develop diabetes. If nothing is done, diabetes will overwhelm the national healthcare system. Diabetes prevention is simple and cost-effective, IDF says. Every year 4 million people die from diabetes of which more than half the deaths can be prevented. 

The doctor advises diabetics to exercise regularly, eat small meals every three hours and most importantly keep stress under control.to save your vital organs and your precious life.