Advertisement

Obesity Surgery

, Volume 29, Issue 1, pp 292–296 | Cite as

Pre-operative Very Low Calorie Ketogenic Diet (VLCKD) vs. Very Low Calorie Diet (VLCD): Surgical Impact

  • Alice AlbaneseEmail author
  • L. Prevedello
  • M. Markovich
  • L. Busetto
  • R. Vettor
  • M. Foletto
Original Contributions

Abstract

Background

Pre-operative diet may play an important role as far as patients’ fitness for surgery, post-operative outcomes, and successful weight loss. Our aim was to compare surgical outcome and weight loss in two groups of patients who were offered two different pre-operative kinds of diet: very low calorie diet (VLCD) and very low calorie ketogenic diet (VLCKD).

Methods

Patients candidate for bariatric surgery (laparoscopic sleeve gastrectomy) were registered and assessed according to pre- and post-diet BMI, operative time, hospital stay, drainage output, and hemoglobin (Hb) levels. Patients’ preference influenced the type of diet.

Results

From January to December 2016, 178 patients (139 F and 39 M) were enrolled in this study. The mean age was 43 years. In total, 72 patients were on VLCKD while 106 patients on VLCD. Pre-diet mean BMI was 46.3 ± 6.3 kg/m2 for VLCKD group and 43.1 ± 6.9 kg/m2 for VLCD group, while immediately pre-op BMI were 43.9 ± 5.9 kg/m2 and 41.9 ± 6.8 kg/m2, respectively. Drainage output and hemoglobin levels after surgery resulted significantly correlated with diet induced BMI reduction (141.2 ± 75.8 vs. 190.7 ± 183.6 ml, p = 0.032; 13.1 ± 1.2 vs. 12.7 ± 1.5 g/l, p = 0.04). The percentage of patients requiring a hospital stay longer than anticipated (> 3 days) was 2.8% in the VLCKD group and 10.4% in the VLCD group (p = 0.048).

Conclusions

In our experience, VLCKD showed better results than VLCD on surgical outcome, influencing drainage output, post-operative hemoglobin levels, and hospital stay.

Keywords

Bariatric surgery Pre-operative diet Laparoscopic sleeve gastrectomy 

Notes

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

Statement of Human and Animal Rights

For this type of study, formal consent is not required.

References

  1. 1.
    Busetto L, Segato G, De Luca M, et al. Pre-operative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004;14:671–6.CrossRefGoogle Scholar
  2. 2.
    Andrianzen Vargas M, Cassinello Fernandez N, Ortega SJ. Preoperative weight loss in patients with indication of bariatric surgery: which is the best method? Nutr Hosp. 2011;26(6):1227–30.Google Scholar
  3. 3.
    Al Khalifa A, Mathew TC, Al Zaid NS, et al. Therapeutic role of low carbohydrate ketogenic diet in diabetes. Nutrition. 2009;25:1177–85.CrossRefGoogle Scholar
  4. 4.
    Dashti HM, Mathew TC, Khadada M, et al. Beneficial effects of ketogenic diet in obese diabetic subjects. Mol Cell Biochem. 2007;302:249–56.CrossRefGoogle Scholar
  5. 5.
    Fried M, Yumuk V, Oppert J-M, et al. Interdisciplinary European guidelines on metabolic and bariatric surgery. Obes Facts. 2013;6:449–68.CrossRefGoogle Scholar
  6. 6.
    Gilden Tsai A, Wadden TA. The evolution of very low calorie diets: an update and meta-analysis. Obesity. 2006;14:1283–93.CrossRefGoogle Scholar
  7. 7.
    Deitel M, Greenstein JR. Recommendations for reporting weight loss. Obes Surg. 2003;13:159–60.CrossRefGoogle Scholar
  8. 8.
    Gerber P, Anderin c, Thorell A. Weight loss prior to bariatric surgery: an updated review of the literature. Scand J Surg. 2015 Mar;104(1):33–9.CrossRefGoogle Scholar
  9. 9.
    Schiavo L, Sanas A, Scalera G, et al. Why pre-operative weight loss in preparation for bariatric surgery is important. Obes Surg. 2016 Nov;26(11):2790–2.CrossRefGoogle Scholar
  10. 10.
    Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;4(9):1165–70.CrossRefGoogle Scholar
  11. 11.
    Schwartz ML, Drew RL, Chazin Caldie M. Laparoscopic Roux-en-Y gastric bypass: preoperative determinants of prolonged operative times, conversion to open gastric bypasses and post-operative complications. Obes Surg. 2003;13:734–8.CrossRefGoogle Scholar
  12. 12.
    Heisson M, Rolland C, KulKarni U, et al. Systematic review of randomized controlled trials of low carbohydrate vs low fat/low calorie diet s in the management of obesity and its comorbidities. Obes Rev. 2009;10:36–50.CrossRefGoogle Scholar
  13. 13.
    Gustafsson UO, Scott MJ, Schwenk W, et al. Guidelines for perioperative care in elective colonic surgery: Enhanced Recovery After Surgery (ERAS) Society recommendations. Clin Nutr. 2012;31:783–800.CrossRefGoogle Scholar
  14. 14.
    Gupta L, Khandelwal D, Kalra S, et al. Ketogenic diet in endocrine disorders: current perspectives. J Postgrad Med. 2017;63(4):242–51.CrossRefGoogle Scholar
  15. 15.
    Iossa A, Abdelgawad M, Watkins BM, et al. Leaks after laparoscopic sleeve gastrectomy: overview of pathogenesis and risk factors. Langenbeck's Arch Surg. 2016;401(6):757–66.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Bariatric UnitPadua University HospitalPaduaItaly

Personalised recommendations