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Ileal Transposition Surgery: Mechanisms of Weight Loss and Diabetes Improvements

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Obesity and Diabetes

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Abstract

Bariatric surgeries produce weight loss with improvements in diabetic control through multiple mechanisms, including enhanced stimulation of the lower gut. The ileal transposition surgery was initially developed to gain insights into the lower gut mechanisms that contribute to the anorexic and weight loss effects of roux-en-Y gastric bypass, without the confounds of gastric restriction or foregut exclusion. Though ileal transposition surgery leads to hypophagia and weight loss, depending on the length of the ileum transposed, remarkably, improvements in glycemic control occur independent of changes in body weight. Some of the mechanisms that have been proposed, to explain the weight loss and glycemic benefits of ileal transposition surgery, include enhanced lower gut stimulation and consequent adaptation, increased secretion of lower gut peptides such as glucagon-like peptide-1 and peptide YY, alterations in enterohepatic bile acid metabolism, and improvements in glucose and lipid metabolism in liver, muscle, and adipose tissue. A greater understanding of the mechanisms of action of ileal transposition surgery may lead to the development of more effective and less invasive interventions that can reproduce the effects of the surgery, without attendant surgical risks and long-term complications.

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Acknowledgments

This chapter is dedicated to the memory of Dr. Henry Koopmans—a colleague, friend, mentor, and a visionary who left a legacy on the lower gut control of energy balance. I would also like to acknowledge the contributions of my lab members—Drs. Adel Pezeshki, Saima Nausheen, and Imran Shah, and Adam Ramzy, who contributed immensely to the work on IT surgery. The work is supported in part by the Koopmans Memorial Research Fund, a Grant-in-Aid from the Heart and Stroke Foundation of Alberta, NWT & Nunavut, and Natural Sciences and Engineering Research Council of Canada.

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Authors and Affiliations

  1. Faculty of Veterinary Medicine, Department of Production Animal Health, University of Calgary, HS 1871, 3330 University Drive NW, Calgary, AB, Canada, T2N 4N1

    Prasanth K. Chelikani

  2. Gastrointestinal Research Group, Calvin, Phoebe and Joan Snyder Institute for Chronic Diseases, University of Calgary, Calgary, AB, Canada

    Prasanth K. Chelikani

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  1. Prasanth K. Chelikani
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Correspondence to Prasanth K. Chelikani .

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Editors and Affiliations

  1. Gastroenterology Department, University of Sao Paulo, Hospital das Clinicas, Sao Paulo, São Paulo, Brazil

    Joel Faintuch

  2. Radiology Department, Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, Massachusetts, USA

    Salomão Faintuch

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Chelikani, P.K. (2015). Ileal Transposition Surgery: Mechanisms of Weight Loss and Diabetes Improvements. In: Faintuch, J., Faintuch, S. (eds) Obesity and Diabetes. Springer, Cham. https://doi.org/10.1007/978-3-319-13126-9_8

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  • DOI: https://doi.org/10.1007/978-3-319-13126-9_8

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  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-13126-9

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