Preoperative Very Low-Calorie Diet Reduces Technical Difficulty During Laparoscopic Cholecystectomy in Obese Patients

Abstract

This study investigates the effectiveness of preoperative very low-calorie diet (VLCD) in laparoscopic cholecystectomy. A prospective observational study of consecutive patients undergoing laparoscopic cholecystectomy was undertaken. At the preoperative visit, all patients were advised to adhere to VLCD for 2 weeks before surgery (<800 kcal/d). Patients were judged to have complied with the VLCD if weight loss >2 kg. Technical difficulty was assessed using questionnaires. A total of 38 patients met the inclusion criteria. Difficulty of visualization and dissection of Calot's triangle in obese patients was twice that of nonobese patients (P=0.01). In 62% of procedures involving obese VLCD noncompliant patients, the surgeon experienced ≥1 area of technical difficulty, compared with 0% of procedures on obese, compliant patients (P=0.018). Difficulty of dissection of the gallbladder bed was 3 times higher in obese, noncompliant patients, compared with obese, compliant patients (P=0.07). Adherence to a 2-week preoperative VLCD may reduce technical difficulty of laparoscopic cholecystectomy in obese patients.

Preoperative weight loss program involving a 20‐day very low‐calorie diet for obesity before laparoscopic gastrectomy for gastric cancer

“…One possible explanation for the beneficial effects on intraoperative and postoperative outcomes might be the reduced technical complexity associated with the reduced visceral fat and liver volume. Similar effects were found in a prospective observational study and a randomized controlled trial involving a 2‐week VLCD before elective laparoscopic cholecystectomy for patients with obesity . Liver size reduction was not observed in the present study.…”

Implementation of a very low calorie diet program into the pre‐operative model of care for obese general elective surgery patients: Outcomes of a feasibility randomised control trial

“…The intervention group had a greater weight loss (5.5%) and reduction in FM without excessive loss of MM, compared to the control group. Similar weight loss of between 4% and 15% has been reported in non‐bariatric surgery patients using a pre‐surgical calorie restricted diet 21, 32, 33, 38 . A high proportion of weight loss (85%) was from FM in participants receiving the VLCD intervention, likewise other studies evaluating low calorie diets on body composition showed 68.9 ‐ 85% of weight loss was from a reduction in FM without excessive loss of muscle mass 39, 40 .…”

“…The demand for this pre‐surgical intervention is demonstrated by a significantly higher clinic appointment attendance rate. The attendance rates are on the higher end of those reported in the literature demonstrating a range of 30% to 97% adherence to pre‐surgical VLCDs across programs of 2‐12 week duration 21, 32, 33 . Weight loss above 5% of initial body weight was associated with presence of urinary ketones ( P = <.02), demonstrating an induced state of ketosis, reflecting high adherence to the VLCD program.…”

Implementation of a pre-operative Very Low Calorie Diet weight loss program into the pre-operative model of care for obese general elective surgery patients

“…bariatric surgery produces greater weight loss and maintenance of lost weight than that produced by usual care, conventional medical treatment, lifestyle intervention, or medically supervised weight loss, Weight loss at 2 to 3 years following a variety of surgical procedures in adults with presurgical BMI ≥30 varies from a mean of 20% to 35% of initial weight and mean difference from nonsurgical comparators of 14% to 37% depending on procedure bariatric surgery produces greater weight loss and maintenance of lost weight than that produced by usual care, conventional medical treatment, lifestyle intervention, or medically supervised weight loss, . 19,31,33,35,73,74 Of these studies, one reported on technicality difficulty of performing the surgery 73 , five reported on weight loss as an end point, showing a range of 4-15% weight loss. 19,31,33,35 This was achieved by using energy restricted diets (VLCD and LCD) that included commercial hypocaloric liquids or a combination of food and hypocaloric liquids (456-1109 calories/day).…”

“…32 2.6.3 Impact of pre-operative weight loss using VLCDs on surgical complications to bariatric and non-bariatric surgery on surgical complications. 19,[25][26][27][30][31][32][33][34][35][73][74][75][76] Of these studies, only four studies were conducted in patients undergoing non-bariatric surgery 19,31,33,73 ; of which Burnand (2016) and Jones (2016) investigated impact of pre-operative weight loss on obese general surgery patients only.…”