What is Laparoscopic Transit Bipartition (LTB)? – drfuadahmed

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What is Laparoscopic Transit Bipartition (LTB)?

LTB is a newly developed technique to not only lose weight but control metabolic conditions such as diabetes as well. This surgery is often done together with Sleeve Gastrectomy where the stomach is first made smaller by removing about 80% of its size, followed by connecting the most distal part of the small intestine to the newly formed smaller stomach. Finally, the original small intestine is rerouted to attach to this newly formed tract, creating 2 pathways or “partitions” for food to pass, hence the name.

What Does “Laparoscopic” mean?

A laparoscopic approach to surgery means using 3 tiny incisions to do the surgery (two 5 mm in length, and one 12 mm in length), as opposed to the regular approach where a large incision is made in your abdomen. The surgeon would use a specialized thin long telescope to which a camera is connected known as the Laparoscope together with some very small surgical instruments to reach the surgical area without opening up your belly too much. This means less scarring as most of these incisions are hidden, less pain during the post-operative recovery period, and fewer surgical complications. It is the approach of choice for most bariatric surgeries.

Do I Need LTB Surgery?

Unlike other bariatric surgeries that are mainly designed to lose weight, LTB is mainly indicated for people who are obese but are mainly complaining of metabolic disorders such as diabetes. A person is obese when his Body Mass Index (BMI) – which is the ratio of your weight to your height – is more than 30. When LTB is used with other bariatric surgeries such as sleeve gastrectomy, you could both lose excess weight and control diabetes as well.

How is LTB Done?

The surgery is usually done in 3 steps:
1. Sleeve gastrectomy is done by removing 70% of the stomach, converting the traditional sac shape into an elongated “sleeve” the size of a banana.
2. The connection between the small intestine and the large intestine is identified and cut, and attached to the newly formed stomach.
3. The original pathway of the intestine is rerouted to attach to this newly formed tract to make use of all the hormones that aid in digestion, as well as the GIP hormone which stimulates Insulin release.
The entire surgery is done using the laparoscope and small surgical instruments, speeding up the recovery process. After the surgery is finished, you’ll have 2 pathways for food to move through. The newly formed shorter route receives about 80% of the ingested food, while the original longer route receives the remaining 20%. This would help you both lose weight by eating less and regulate diabetes by stimulating the production of Insulin. You’ll need to stay at the hospital for a few days for recovery.

Life After LTB

As we explained, LTB is usually done with sleeve gastrectomy, which is a form of bariatric surgery that requires you to make some changes to your lifestyle. We recommend you follow the following steps to get the most out of your surgery:
· The rapid drop in body weight can sometime cause a few unwanted but completely expected side effects during the first 6 months of surgery. These include body aches, hair loss, mood changes, dry skin, and constantly feeling tired. All you need to do is support yourself both physically and mentally, and know this is a temporary phase that will pass very soon.
· For 2 weeks after the surgery, you would be limited to a liquid diet, and would gradually transition to pureed food, soft food, and then regular food in about 1 month. Do not rush the process of returning to hard foods so as not to risk nausea and vomiting.
· Eat very slowly and chew your food very well, since your smaller stomach does not have the same capacity for digestion as it used to.
· The biggest advantage of LTB over other bariatric surgeries is that the entire digestive tract is retained, which means that food and nutrients absorption is only mildly affected, limiting the need for supplements and vitamins. However, we recommend you undergo blood tests every few months to make sure you don’t suffer from anemia or low blood sugar.

Some Other Life Changes to Consider

LTB and other bariatric surgeries affect every aspect of your life, so you would need to change some of your lifestyle choices to cope with the effects of the procedure. These include smoking, drinking alcohol, and some medications such as ibuprofen, Voltaren and Aspirin which will all need to be used with moderation.
In addition, not only will you change physically, but it can be hard for some people to cope mentally with the changes of the procedure, especially with the visible signs such as hair loss and dry skin as we mentioned before. Should you feel overwhelmed at any point, there is absolutely no shame in seeking help whether professional or through support groups, family, and friends.

Is LTB the Only Option for Weight Loss?

As we mentioned, LTB is indicated mainly for people with BMI between 30 and 35 who also suffer from metabolic disorders such as diabetes. However, there are other bariatric surgeries to choose from which can be better for your case. Make sure to ask your surgeon about laparoscopic gastric banding, mini gastric bypass, and roux-en-Y gastric bypass.

If you need any more information about the procedure or the follow-up aftercare period,
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