Transit Bipartition

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.

2nd Option: Transit Bipartition

Only important point is that approximately 1/3 of the food passes through the duodenum, which is the natural path, while 2/3 of the food passes through the last segment of the small bowel, thanks to the new connection.

These rates have been determined by the screening tests which are done either with oral contrast material or marked isotopes.

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.