What is Ileal Interposition Surgery?
Ileal Interposition is not only specifically a bariatric surgery, but also is used to treat diseases that target the metabolic syndrome such as Type II diabetes mellitus. Moreover, both foregut (excluding of the duodenum) and hindgut mechanisms are utilized in these procedures. These procedures not only for obese subjects, but is also used for non-obese subjects.
The purpose of Ileal Interposition surgeries as a sum, is to enhance the early stimulation of distal ileal segment with raw and undigested food.
All tree different types of Interposition, bring the distal ileal segment to a close anatomical position in different ways:
- Gastroileal Interposition with Bipartition
- Duodenoileal Interposition
- Jejunoileal Interposition
How it is performed?
Ileal interposition surgery targets the stomach and small intestines. The operation is performed under general anesthesia as a metabolic procedure. The procedure average takes about four hours.
The procedure is conducted laproscopically, with small surgical incisions ranging between 5 mm to 12 mm, made on the abdomen wall.
In the procedure the last part of the small intestine (i.e. ileum) is brought up close to the stomach. A segment of last part of small intestine (ileum) is, dissected and interposed into the 2nd part of small intestine (i.e. jejunum) beyond the stomach.
After the interposition, the terminal part of the ileum is midway between the jejunum and the proximal part of the ileum is connected to the large intestine. No part of the intestine is removed and the length of the intestine is maintained. This allows normal access for any future endoscopic vision, if required.
Who should have Ileal Interposition?
The surgery is the preferably conducted on thin or normal weight diabetic patients who have been suffering from diabetes type II for over three years and which has not responded well to medications and life style changes and the condition is progressively worsening. The patient should be ideally less than 65 years of age.
Surgery is best suited for patients with uncontrolled sugar levels despite all treatment plans, progressive disease with steady deterioration over time, high genetic predisposition, with other members of the family affected. Patients with impending danger of complications to other organs (kidney, eyes or heart) as the best candidates for the surgery.
Preparation before the surgery
The patient has to undergo tests and various investigations to ensure that he/she is fit for the surgery. The patient has to undertake basic investigations like blood sugar (fasting and post prandial), HbA1c and serum insulin.
This is followed by a complete physical examination of the patient to assess the fitness of the patient for anesthesia during the surgery.
A series of required investigations are requested for which include complete blood count, lipid profile, liver function tests, kidney function tests, lung function and X ray of the chest, electrocardiogram, ultrasound of the whole abdomen, etc.
In addition a ophthalmic examination and dental examination are essential prior to the surgery, to assess the extent of complications associated with diabetes and reduce possibility of post operative infections.
Three days prior to the scheduled surgery the patient must go on a liquid diet.
Post operative care and diet after Ileal Transposition
The post operative hospitalization stay may last for four to five days.
Usually patient is allowed to ingest water about six hours after the procedure, while other liquids are allowed about two days after the surgery. Semi solid food is allowed about eight days after the procedure.
For the first couple of days after the procedure the patient would require to be on liquid diet, which is followed by a soft diet for the next couple of days. Subsequently a strong diabetic diet is recommended. Ideal dietary measures include taking small quantities of food. The food has to be consumed at an interval of three to four hours.
For ensuring greater effectiveness of the results, the patient is suggested to limit the consumption of carbohydrates and consume slow digesting carbohydrates like fruits, vegetables and whole grains. In addition the patient should increase the intake of lead proteins and should consume modest amount of unsaturated fat form natural sources like pecans, walnuts, olive oil, almonds, etc.
On an average, the patient can return to routine work about ten to fourteen days after the surgery.
Physical exercise is essential part of ensuring that the body metabolism and level of blood sugar is controlled. It is recommended that the patient start with long walks after about two weeks of the surgery, which is followed by aerobic activities and weight training a month after the surgery. Abdominal exercises are recommended a after three to four months.
What are the complications after Ileal Transposition surgery?
The complications would be very similar to any surgical procedure and would include surgical site infections, hematomas, gastro intestinal problems like nausea, vomiting, etc. In addition bleeding or leakage from the internal organs is a rare possibility. Another complication, which is reported less frequently, includes internal intestinal herniation.