SGIT

SGIT [Ileal Transposition with Sleeve Gastrectomy]

This surgery developed by Dr Aureo-de Paula from Brazil, is performed as part of research at Bombay Hospital, Mumbai. It is performed through laparoscopy or key-hole route. It is expected to help glycemic control in selected type 2 diabetes mellitus patients.

Surgical Steps: SGIT is done under general anaesthesia. This surgery has primarily 2 steps:

Step I : Sleeve Gastrectomy

Click here to view image—Sleeve Gastrectomy

The stomach is stapled along the length and the excess or remnant part of the stomach is removed. This step's usual operating time is 1hr.

Step I : Ileal Transposition

Click here to view image—Isolation of Segment of Terminal Ileum & Division of Jejunum

Click here to view image—Interposition of Ileal Loop in Jejunum Beyond Stomach (Darkened Part)

A segment of last part of small intestine(ileum) is interposed between 2 parts of small intestine(jejunum) just beyond stomach. No part of small intestine is removed or bypassed.

Proposed Mechanisms of Blood Sugar Control: Blood sugar control may be achieved in responders within 10 days – 6 months. The suggested mechanism(s) of blood sugar control are

Contribution of Sleeve Gastrectomy

Reduced food intake—reduced blood sugar spike after a meal.
Reduced Ghrelin hormone secretion, which may have certain role in blood sugar control.

Contribution of Ileal Transposition

Early contact of undigested food(chyle) with interposed segment of ileum results in increased blood levels of GLP-1 hormone levels. GLP -1 is believed to have following effect:
- Glucose even with severe ß-cell impairment
- Stimulates insulin secretion
- Exerts proliferative effect on pancreatic ß
This is believed to result in acute insulin response, which is usually lost in type 2 diabetics. This leads to blood sugar control immediately after a meal.

Post-op Recovery

Immediate

Most of the patients are in recovery/intensive care for 1-2 days due to their medical limitations.
Most of the patients are allowed to have liquids within 24 hours of surgery.
Patients are encouraged to walk by evening on the day of surgery.

Delayed

Usually patients are sent home on the 5th-7th day after surgery.
Patients can resume normal work 2 weeks after discharge from hospital.

Diet Recommendation
Full diet charts are provided by our physician. This includes liquid diet for 2 weeks after surgery, soft diet for another 4 weeks & then normal diet. It is strongly recommended that all instructions are followed to avoid any nutritional imbalance.

Physical Activity Recommendation
During the active weight loss period, human body resists weight loss, this may result in lethargy, less energy expenditure & reduction in metabolic rate. This slows down weight loss, even if patient is eating small food portions. Patients are strongly advised to resume physical activity after surgery to ensure maintenance of body metabolism at high levels.All recommendations are in relation to time after surgery.

Long walks : 10 days later

Aerobic activities like swimming : 20 days later

Weight training etc : 30 days later

Abdominal exercises : 3 months later

Long Term Results
SGIT is based on Hindgut hypothesis derived from Roux-n-y Gastric Bypass surgery. Long term follow up data of gastric bypass has shown 80%-100% blood sugar & insulin maintenance even after 14 years.

Our Results

80% patients are maintaining blood sugar without medication. Other 20% patient(s) also have significant control with reduced medicine requirement.
60% patients were on Insulin while 40% were on oral antidiabetic medication.
Average fasting blood sugar dropped from 256mgm% to 108mgm% within 3 months after surgery.
Mean HbA1c [Glycosylated hemoglobin] fell from average 9 to 7.15 3 months after undergoing diabetes surgery.
Patients who were on Insulin before surgery-66% stopped insulin within 2 months after surgery, remaining 33% decreased their insulin intake by over 80%.