Doctor fights diabetes with surgery

Transit Bipartition is cheaper than other surgeries such as the gastric bypass; it does not favor nutrients malabsorption and requires a less strict medical control

Mexican doctor fights diabetes with low-cost surgery
Dr. Walter Kunz Martínez – Photo: Demian Chavez/EL UNIVERSAL
English 25/09/2019 13:23 Mexico City Natalia Castrejón Actualizada 13:55
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“I went to bed and thought, ‘Who knows if I’ll wake up tomorrow or who knows how the sugar will be?’” tells María Antonio Pérez Pérez who was diagnosed with diabetes ten years ago. This was the announcement of a death sentence in the medium term. Obesity was one of the causes and the numbness in her right arm the symptom that revealed it.

Five years ago, doctor Walter Kunz Martínez, practiced on her a Transit Bipartition, a surgery that allowed her to be born once again. Today, María Antonieta is almost free of diabetes mellitus type 2. She is in complete remission: She does not need medicine to control the sugar levels in her blood; all she has to do is do exercise.

Other patients that went under this surgery, besides reducing or stop consuming anti-diabetic and high blood pressure medication, are also free from the painful insulin injections. In more serious cases, they have avoided dialysis, a procedure that substitutes the functions of the kidneys when they stop working.

Transit Bipartition, done by Walter Kunz and his team in the San Juan del Río General Hospital (HGSJR) in Querétaro, is cheaper than other surgeries such as the gastric bypass, which is also used to control diabetes. In contrast, it does not favor nutrients malabsorption in the organism, it requires a less strict medical control and can be done in hospitals that are not of high specialty.

Facing the problem: Fighting diabetes
Blindness, irreversible damage to the kidneys, amputations, and in the worst case, death, are some of the consequences of diabetes mellitus. In 2017, over 100,000 Mexicans lost their lives to it; this disease was the second cause of death in Mexico, for health issues, according to information of Mexico’s National Statistics and Geography Institute (INEGI).

Each week, Kunz Martínez, head of the Unit of Endocrine and Metabolic Surgery of the HGSJR, amputates at least one patient and his or her family, for the cuts not only affect the patient. The consequences that derive from amputations, such as disability and unemployment, are exhausting and dramatic.

The complicated picture caused by diabetes mellitus was the motivation for the also specialist in endocrine surgery and mini-invasive surgery to fight it. That is why he modified existing techniques and developed the Transit Bipartition surgery.

The surgery consists of connecting the initial and last part of the small intestine; surgeons create a “shortcut” through which food will pass after eating them, but they will also pass through the normal route of the intestine. This will allow the last part of the small intestine to be in early contact with nutrients, it will be stimulated and it will produce incretin hormones.

Incretin hormones are chemical messengers that incite the pancreas to secrete more insulin, which regulates glucose in the blood. When there is not enough or the body does not use it with efficiency, diabetes is developed.

Surgery is efficient to control diabetes because it promotes insulin production, changes in the behavior of bile acids (proteins that help to process foods) and it modifies bacteria in the intestine.

To be born again despite the lack of a cure
Although diabetes can be inherited from the parents, the risk of developing it increases with excess weight and obesity. In the last 30 years, these two diseases became an epidemic that affected 7 out of every 10 adults and 3 out of every 10 Mexican children according to the National Survey of Health and Nutrition (ENSANUT) in 2012.

Five years ago, María Antonia Pérez started an obesity control program in the HGSJR. With diet and exercise, she has lost 30 kilograms. Seeing her commitment, surgeon Walter Kunz proposed her to go under the Transit Bipartition surgery to go a step beyond the control of diabetes mellitus type 2 and she accepted.

Hence, this woman who is currently 65 years old became the first person to receive the treatment. Little by little she reduced her use of anti-diabetic medicines; she no longer uses it. She entered a state of complete remission, which means she has normal levels of glucose in the blood; she is basically free from diabetes.

Kunz Martínez thinks it is daring to assert that a single manipulation in any of the systems of the body “will cure” a disease as complex as diabetes mellitus. Therefore, he says that the best term for it is “remission” instead of “cure” because there are no long-term studies of what will happen with the disease, it could come back.

It is not magic
After the surgery, patients must attend medical consultation from three to six months. Between the six and nine months after the transit bipartition, sugar in the blood will be stable and the use of anti-diabetic medication can be reduced. Each patient will have a different response to the treatment, but results will be better the younger the patient and the less time they have had the disease.

Benefits from transit bipartition are not magic; it requires medical supervision, a balanced diet, and physical activity. Kunz Martínez says that there are many cases of follow-up dropout, but 62% of the first 30 patients are in remission.

María Antonia Pérez is one of them; she attends her medical consultations, practices yoga three times a week, but due to overfeeding she has obesity again. Although she is aware that no food is forbidden to her, she yields to temptation and sometimes eats up to four tortillas; she loves them.

Due to obesity, María Antonia now uses medicine to control blood pressure; after the transit bipartition surgery, she no longer needed it. Although she is embarrassed by the situation, she has not desisted; she keeps doing the hard work; she knows that, for now, she is free from diabetes.

Obstacles and a long way to go
Disbelief from doctors and patients has been one of the main difficulties for the dissemination and practice of the Transit Bipartition surgery. Kunz Martínez explains that when diabetic patients are told “we are going to open your belly to perform surgery on something that is not causing you pain,” many refuse and tell on them with first contact physicians. They, out of lack of knowledge, tell patients that such surgeries do not exist or that they are far from Mexico’s reality.


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