Ileal Interposition with Sleeve Gastrectomy for Type 2 Diabetes Mellitus and Metabolic Syndrome

  • Surendra M. UgaleEmail author
  • Alper Celik


“Diabesity,” ie a combination of type 2 diabetes mellitus (T2DM) and obesity, is increasing in epidemic proportions. Medical management of diabetes mellitus requires that patients remain compliant to their medication regimen and monitor the condition closely; patients are also required to make changes in lifestyle and diet. However, over time the pancreatic B cell function deteriorates and this leads to increased requirement of medications and may also lead to introduction of insulin based therapy. Laparoscopic ileal interposition (II) with sleeve gastrectomy (SG) is an evolving procedure that offers good control of type-2 diabetes and other metabolic derangements and also helps in weight reduction without causing significant malabsorption. In this chapter, the two versions of this procedure, jejunal (non-diverted) and duodenal (diverted) ileal interposition, along with patient selection criteria, mechanisms of action, postoperative care and follow up, and its advantages are described. This is a promising procedure for control of type 2 diabetes, hypertension, obesity, and associated metabolic abnormalities in obese but also in non-obese.


Type-2 diabetes Metabolic syndrome Co-morbidities Ileal interposition GLP-1 Incretins Ileal brake Remission 

Supplementary material

Video 58.1

Third transection with suture marking, confirming wide mesentery base (MPG 89412 kb)

Video 58.2

First anastomosis ileo-ileal 30 cm from ICV (MPG 61128 kb)

Video 58.3

First mesenteric defect closure (MPG 160038 kb)

Video 58.4

Duodenal dissection beyond gastroduodenal artery and transection of first part (MPG 76696 kb)

Video 58.5

Creation of retro-colic opening and delivery of gastroduodenal sleeve (MPG 74082 kb)

Video 58.6

Second anastomosis duodeno-ileal in one layer (MPG 109178 kb)

Video 58.7

Two layer duodeno-ileal anastomosis (MPG 144766 kb)

Video 58.8

Measure 50 cm from ligament of Trietz and suture marking on jejunum (MPG 43164 kb)

Video 58.9

Second mesenteric defect closure with posterior fixation of duodeno-ileal anastomotic region (MPG 159702 kb)


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Copyright information

© Springer International Publishing Switzerland 2016

Authors and Affiliations

  1. 1.Department of Advanced Laparoscopy and Metabolic SurgeryKirloskar HospitalHyderabadIndia
  2. 2.Sisli Kolan International HospitalIstanbulTurkey

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