A randomised, single blinded trial, assessing the effect of a two week preoperative very low calorie diet on laparoscopic cholecystectomy in obese patients

Abstract

61630192. http://www.isrctn.com/ISRCTN61630192 Trial registration.

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.…”

“…Whilst it is acknowledged the present study is not powered to detect a significant difference in surgical outcomes, results are suggestive of the utility of pre‐surgical VLCDs to induce positive clinical benefits to patient and health outcomes including a reduction in wound infection and shorter intra‐operative time. Burnand demonstrated significant reduction in theatre time in a study evaluating the impact of a 2‐week VLCD program prior to cholecystectomy, with average weight loss of 3.7% 21 . Furthermore, a randomised multi‐centre trial of n = 298 patients by Van Nieuwenhove found that the intervention group (VLCD) had a significant higher weight loss (3.8%), compared to the control group and this was associated with a reduction in the number of overall post‐operative complications (18 vs 8 – non‐significant) 42 …”

“…Conversely, a retrospective analysis of 1721 patients undergoing elective laparoscopic colectomy found no association between obesity and risk of surgical complications 19 . However, there are a number of studies that report the association between pre‐operative weight loss and reduction in surgical complications in patients with obesity undergoing bariatric surgery 8, 11, 20, 21 . The inconsistencies in findings highlight a clear gap for further exploration.…”