Transit Bipartition | Prof. Dr. Haluk Ünalp

Transit Bipartition

TRANSIT BIPARTITION SURGERY WITH SLEEVE GASTRECTOMY

This method, first described by Brazilian surgeon Sergio Santoro, actually involves a technique that combines sleevegastrectomy surgery with R-Y gastroenterostomy surgery. Following a larger tube gastric surgery, a calculated part of the small intestine is mouthed into the stomach, and 2 different passage routes are created, both from the pylorus (physiological path) and the newly opened path.

HOW IS THE SURGERY PERFORMED (TECHNICAL)

In this application, a tube stomach surgery is applied first. Here, the stomach volume is left a little wider than the tube stomach. Then the junction of the small intestine and large intestine is found (ileocecal junction). Starting from this junction, the small intestine is counted as centimeter backward. It is reached from the ileocecal junction 100 - 120 cm. This point is marked. (Depending on the patient, this part can be 80-200 cm). Continuing to count, reach 250-270 cm from the ileocecal junction. In other words, it will be 150 cm higher than the place where we made the sign. (Depending on the patient, this distance can be 50-150 cm) When it reaches the 100-120 cm up to the marked place and 150 cm from there, that is a total of 250-270 cm, this small intestine is partially cut and divided into two. Now we have 2 small intestine ends. The lower end, which is calculated from the ileocecal junction, is drawn towards the lower part of the stomach. The end of the 250-270 cm intestine up to the ileocecal junction is aimed to be mouthed with the lower part of the stomach. For this purpose, the stomach and small intestine are mouthed with a window opened in a suitable area in the lower part of the stomach and some of the food is passed through this 250-270 cm part. However, the upper end of the small intestine that we cut and cut from 250-270 cm remains in our hands. Here comes stomach acid, bile, pancreatic fluid, etc. At this end, we initially calculate from the ileocecal junction and mark 100-120 of the small intestine. It is mouthed with cm part.

 

WHICH WAY DO THE FOOD GO?

Studies with oral contrast media or labeled isotopes in these patients have shown:

While 2/3 of the food passes from the newly opened road to the small intestine, 1/3 of the food taken passes to the small intestine through the physiological route due to the periodic stopping of the food passage by the valve system called pylorus.

ADVANTAGES

✓ Unlike other obesity surgeries, the risk of developing vitamin deficiency is lower in this group of patients (less than 10%). On the other hand, the risk of developing anemia is less than 7%. Therefore, 95% of patients who have this surgery do not need to use vitamins and iron regularly for life. Because the protection of the antrum and the physiological functioning of the pylorus and duodenum eliminates the need for vitamin, mineral, iron and calcium supplements.

✓ Since the intra-stomach pressure is low, this postoperative leakage rate is lower than the rate of leakage in the tube stomach.

✓ There is no stomach area that is not seen in these postoperative endoscopic interventions (as in gastric bypass surgery), all remaining stomach can be seen. Although it is experienced in SADI-S or Gastric bypass, this surgery does not prevent access to the duodenum and bile ducts, and this surgery does not prevent endoscopic interventions in both diagnosis and treatment.

✓ Its effect is good in obesity treatment and its full control rate for diabetes is 86%.

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