Ileal Transposition [IT]

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 glycaemic control in selected type 2 diabetes mellitus patients.

Ileal Transposition
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

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 day after surgery.
  • Patients can resume normal work 2 weeks after discharge from hospital.
Diet Recommendation
This includes liquid diet for 1-2 days after surgery, soft diet for another 2-3 days & then normal diet. It is strongly recommended that diabetic diet is followed.
Physical Activity Recommendation
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
IT 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.

Ileal transposition [IT] is performed by expert surgeons at the following Alhilal Hospitals Centres. Click on the location to make an appointment.