Gained to the medicine literature by the Brazilian surgeon Sergio Santoro, this surgical technique is similar to the other techniques as it is a combined operation with sleeve gastrectomy procedure. However, unlike similar procedures, the entire distal part of small bowel is brought to the lower
stomach and a second exit is provided, therefore all the food can pass through the entire small bowel segments.
In this procedure, 100 or 120 cm starting from the connection point between the small bowel and the large bowel is measured and marked. The choice between 100 or 120 cm is determined according to patient characteristics.
Afterwards, another 150 cm is measured, and small bowel is dissected at 250 cm distance to the connection between the small bowel and the large bowel. Dissected lower end is connected to the stomach. Higher end is connected to the 100th cm marked beforehand. As a result, direct food passage is granted to the last 250 cm part of the small bowel.
Iron and vitamin deficiencies in diabetic patients
• Vitamin D and Vitamin B1 (thiamine) deficiencies in diabetic and especially obese diabetic patients who never had any surgery before is quite common (%32-60 and %18-45, respectively).
• In the same patient groups, iron deficiency is also reported between %8-19.
Transit Bipartition Results:
• 5 year follow up results of the patients who underwent Transit Bipartition operation show that the need for these vitamins is below %10.
• Main advantage of this operation is that less than %7 of the patients have a blood hemoglobin value of 12 gr/dl (between 10-12 gr/dl).
• Long term iron supplement requirement has not been observed in any of the patients except thalassemia carriers.
• About %95 of the patients can continue their lives without any supplement.
Transit Bipartition Other Advantages
• Low intragastric pressure and accordingly prevention of sleeve leaks.
• Preservation of the sleeve size and prevention of sleeve dilatation in the long term, both thanks to low intragastric pressure.
• Entirety of the small bowel can be reached by endoscopic means. This prevents gall bladder,
pancreas and bile channels being unreachable, which is commonly seen in techniques that disable the duodenum.
• Food passage and absorption through the entire digestive system
• Any part of the digestive system can be reached by endoscopic means
• Duodenum and the bile channels can be reached with ERCP
• Preservation of the antrum, the pylorus and the duodenum remove the need for vitamin, mineral, iron and calcium supplement
Bariatric and Metabolic Outcomes
• 5 year results of Transit Bipartition operation have been published in 2012, which show that in this 5 year period, patients lost %74 of their excess weight and %86 of the patients achieved blood sugar control without medication.
• Preliminary reports of 8 year results state that these rates have been preserved at the same level.
How is Loop Transit Bipartition Performed?
The first stage of the procedure is a slightly larger sleeve gastrectomy. By this means, the effect of the Ghrelin effect i.e. the reduced appetite, and the attenuation of the antiinsulin mechanism are utilized. Afterwards, a passage is formed in such a way as to ensure it to extent from a little bit behind the gastric outlet to the point located 250 cm behind the junction of the small and large intestines.
In scintigraphic studies, it has been showed that 2/3 of the gastric content passes through the newly formed passage, while the rest of it passes through the pylorus. The advantages achieved in this way are as follows:
Since it also have absorption-reducing effect, it promises a greater weight loss effect than sleeve gastrectomy. Leakage is the most frightening complication of sleeve gastrectomy.
The most important cause of the leakage is high pressure. This anastomosis reduces the risk of leakage by reducing the gastric pressure and. The hormonal thermostat mechanism is corrected because it both restricts caloric intake and accelerates the gastric-emptying process. Since no part of the digestive system is by-passed, the concerns arising from gastric bypass are eliminated. All regions of the digestive system are endoscopically accessible.
Since a certain portion of foods passes through the normal way, it causes less vitamin mineral deficiencies compared to SADI-S, one of the potent surgical procedures.
The intestinal distance can be adjusted based on the severity of the diabetes. The surgery can be easily reversed.
It is a revision procedure that can be performed much more practically than any other revision procedures, especially after sleeve gastrectomy, following which weight regain is observed.
We are the pioneer in also loop transit bipartition besides many other bariatric surgery procedures.
All the success levels targeted for patients have been achieved up until now. No leakage or major complication has developed.
