Loop Bipartition

The fact that obesity and diabetes’ being the most important health problems which threaten the world has opened the way for innovations in obesity and metabolic surgeries. With the discovery of neuroendocrine hormones (GLP-1, PYY, Ghrelin) and it’s impacts on satiety-appetite mechanisms, in surgical strategies, the methods which the intestines are used became more popular. New methods aim to use neuroendocrine effects rather than creating mechanical restriction and absorption disorder.

Transit bipartition which is similar with duodenal switch surgery but in which duodenum is not closed is the oldest of the metabolic surgery methods and it has been implemented for about 40 years. It was revealed that since the duodenum is not closed, absorption-vitamin impairment has been less and it has opened the way for neuroendocrine effect surgeries.

The middle and last part of the small intestines’ previously meeting with the meals will form the feeling of satiety at once. These methods in which the main pathway is not blocked, the neuroendocrine effect is maximum and the absorption defects are minimal. In comparison with the surgery types in which a part of the stomach or intestine is bypassed directly (rny gastric bypass-mini gastric bypass-duodenal switch-SADI), with this method, as long as the nutrition without glucose is provided, there will be no or there will be very little vitamin deficit.

There are two groups of bipartition surgeries and these are; 1-transit bipartition 2-loop bipartition.

In loop bipartition (tube stomach + bypass) surgery, the classical tube stomach is made and in addition to that a second pass is made from the stomach to the middle of the small intestine without touching the anatomical exit of the stomach. This connection is generally is applied to the small intestine 250 cm back from the origin of the large intestine. In some situations, a piece is not used for this and the moving bowel is easily brought to the lower end of the remaining stomach and they are combined. In general, the size of the transition should be between 2.5-3 cm. In some cases, the size of the opening can be changed when the patient loses much weight or when her/his losing weight is not sufficient. It is a good choice in obese patients with open blood glucose over 126 or in patients with high resistance.

With its restrictive effect and neuroendocrine effect it is preferred especially in carbohydrate addicts. Removal of the Ghrelin hormone which is known to be effective in the appetite mechanism and mostly secreted from the fundus part of the stomach as it’s also subtracted in classical sleeve gastrectomy will provide reduction in appetite. Again, as in classical sleeve gastrectomy, the occlusion signal will be obtained quickly and in small amounts. The satiety hormone GLP-1 is in the middle of the small intestine and is produced rapidly with this connection and as it takes a meal, the satiety signal is sent to the brain. The aim of this surgical method is not to create an absorption defect but to activate the hormonal system quickly. In carbohydrate intake, bowel movements quicken and diarrhea attacks occur. The first part of the intestines is where glucose absorption is more frequent. The effort of the brain to remove the sugar quickly which passes to the last part without being absorbed from the intestine is caused by the absorption of water from the body into the intestine and by the diarrhea mechanism that is formed. The only way to prevent this situation is not to take glucose into the body. Other characteristic effect in this surgical method; again, with the rapid activation of the hormone called PYY which is secreted from the middle and last part of the small intestine is a change in taste and occurrence of disgust especially against animal fatty foods. Most patients may complain of pregnancy-like symptoms for a length of time.

In this type of bypass, since the main exit of the stomach is not touched, the anatomy of the duodena and stomach will not be impaired. This allows the application of ERCP which is used as the gold standard in viewing and curing the bile tracts. Reforming this surgical method is much simpler than other types of bypass.