Randomized Clinical Trial To Compare The Effects Of Preoperative Oral Carbohydrate Loading Versus Placebo On Insulin Resistance And Cortisol Level After Laparoscopic Cholecystectomy*

Abstract

We believe that CHO-loading is not clinically justified in case of laparoscopic cholecystectomy. No effect on the levels of glucose, insulin resistance and cortisol was observed. Even though such procedure is safe, in our opinion there is no clinical benefit from CHO-loading prior to laparoscopic cholecystectomy.

Are carbohydrate drinks more effective than preoperative fasting: A systematic review of randomised controlled trials

“…Levels two and three represent those with mild or severe systemic disease. Of the studies assessed, eleven included patients with an ASA grade of I‐II (Bisgaard et al, ; Faria et al, ; Hausel et al, ; Hausel, Nygren, Thorell, Lagerkranser, & Ljungqvist, ; Kaška et al, ; Noblett et al, ; Pexe‐Machado, Oliveira, Dock‐Nascimento, & Aguilar‐Nascimento, ; Sada et al, ; Yagmurdur, Gunal, Yildiz, Gulec, & Topkaya, ; Yildiz, Gunal, Yilmaz, & Yucel, ; Yilmaz et al, ), five studies included patients with ASA grade of I‐III (Mathur et al, ; Pędziwiatr et al, ; Savluk et al, ; Wang, Wang, Wang, & Qin, ; Yang, Yan‐Bing, Xue‐Long, Dong, & Zhi‐Hao, ), and six trials did not state the patients’ ASA grade (Järvelä, Maaranen, & Sisto, ; Lidder et al, ; Rapp‐Kesek, Stridsberg, Andersson, Berne, & Karlsson, ; Singh et al, ; Webster et al, ; Yuill, Richardson, Davidson, Garden, & Parks, ).…”

“…The 22 trials included in this review were conducted across 13 different countries: four in Turkey (Savluk et al, ; Yagmurdur et al, ; Yildiz et al, ; Yilmaz et al, ), two in Brazil (Faria et al, ; Pexe‐Machado et al, ), three in the UK (Lidder et al, ; Noblett et al, ; Yuill et al, ), three in Sweden (Hausel et al, ; Hausel et al, ; Rapp‐Kesek et al, ), two in China (Wang et al, ; Yang et al, ) and one each in Poland (Pędziwiatr et al, ), Australia (Webster et al, ), Denmark (Bisgaard et al, ), New Zealand (Mathur et al, ), Kosovo/Serbia (Sada et al, ), Czech republic (Kaška et al, ), India (Singh et al, ) and Finland (Järvelä et al, ).…”

“…Of the three trials focusing on cardiac surgery, two explored fasting in those undergoing coronary artery bypass grafting (Järvelä et al, ; Savluk et al, ) while the other included patients experiencing cardiopulmonary bypass (Rapp‐Kesek et al, ). From the nineteen abdominal surgery‐based trials, seven included those having a laparoscopic cholecystectomy (Bisgaard et al, ; Faria et al, ; Hausel et al, ; Pędziwiatr et al, ; Singh et al, ; Yildiz et al, ; Yilmaz et al, ), while five focused on colorectal surgery (Kaška et al, ; Lidder et al, ; Noblett et al, ; Wang et al, ; Webster et al, ). Of the remaining papers, one each focused on patients undergoing gastrointestinal resections (Pexe‐Machado et al, ), radical distal gastrectomy (Yang et al, ), inguinal hernia repair (Yagmurdur et al, ) and liver resections (Mathur et al, ).…”

“…Five trials involving 482 patients investigated the effect of preoperative carbohydrate drinks on “length of stay” compared to placebo (Mathur et al, ; Pędziwiatr et al, ; Sada et al, ; Yang et al, ; Yuill et al, ). In all five trials, length of stay in the carbohydrate group was not significantly shorter than the placebo group.…”

“…Five trials involving 440 patients investigated the effect of preoperative carbohydrate drinks on “insulin resistance” compared to placebo. Of the five trials, three reported a significant reduction in insulin resistance in the carbohydrate group (Lidder et al, ; Wang et al, ; Yang et al, ) and one a slight reduction in insulin resistance but no significant effect when compared to placebo (Mathur et al, ), while insulin resistance actually increased in one trial (Pędziwiatr et al, ).…”