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Preoperative Fasting of 2 Hours Minimizes Insulin Resistance and Organic Response to Trauma After Video-Cholecystectomy: A Randomized, Controlled, Clinical Trial

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Abstract

Background

Studies showing the improvement of insulin sensitivity by reducing the term of preoperative fasting are mostly done in patients undergoing major operations. More information about the role of shortened preoperative fasting in perioperative metabolism is needed for such elective minor/moderate abdominal procedures as laparoscopic cholecystectomy. We investigated the influence of a carbohydrate-rich drink given 2 h before laparoscopic cholecystectomy on insulin resistance and the metabolic response to trauma.

Methods

A group of 21 female candidates (18–65 years old) for elective laparoscopic cholecystectomy were randomized to either an 8 h fasting group (control group: n = 10) or to a group receiving 200 ml of a carbohydrate beverage containing 12.5% (25 g, 50 kcal per 100 ml and approximately 285 mOsm) of maltodextrine 2 h before operation (CHO group: n = 11). Blood samples for various biochemical assays were collected both at induction of anesthesia and after the 10th postoperative hour. Insulin resistance was assessed by the HOMA-IR equation (Insulin (μU/ml) × blood glucose (mg/dl)/405).

Results

There were no postoperative complications. Seventy percent (7/10) of the controls and 27.3% (3/11) of the CHO group experienced at least one episode of vomiting (RR = 2.42, 95% Confidence Interval [CI] = 0.88–6.68; P = 0.08). Biochemical analysis showed that serum glucose (P < 0.01), insulin (P < 0.01), lactate/pyruvate ratio (P = 0.03), and triglycerides (P < 0.01) for the control group were higher than for the CHO group. The value of HOMA-IR was significantly greater (P = 0.03) in the conventionally fasted patients than in the CHO group.

Conclusions

Abbreviation of the period of preoperative fasting and administration of a carbohydrate beverage diminishes insulin resistance and the organic response to trauma.

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Acknowledgments

The authors thank CNPq (Conselho Nacional de Desenvolvimento Cientifico e Tecnológico for funding the study (grant 401943/2005-4), and Dr. Cervantes Caporossi for including his patients in the study. All authors participated in the elaboration of the study. Marcelo Sepulveda Faria has participated in the study design, operation of the patients, collection, assembly, analysis, and drafting of the manuscript. Osvânio Salomao Pimenta and Luis Carlos Alvarenga Jr. have participated in all operations and collection of blood samples. Natasha Slhessarenko has participated of the study design and laboratory assays, and Diana Borges Dock-Nascimento has participated in the study design and in the composition of the diets. José Eduardo de Aguilar-Nascimento conceived the study, analyzed the data, and edited the manuscript.

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Authors and Affiliations

  1. Department of Surgery, Medical Sciences School,The Federal University of Mato Grosso, Rua Estevão de Mendonça 81 apto 801, 78030-300, Cuiaba, Brazil

    Marcelo S. M. Faria, José E. de Aguilar-Nascimento & Natasha Slhessarenko

  2. Department of Medicine, Santa Rosa Hospital, Rua Adel Maluf 199, 78000-000, Cuiaba, Brazil

    Osvânio S. Pimenta & Luis C. Alvarenga Jr

  3. Nutrition School, Nutritional Therapy Team of Julio Muller Hospital, The Federal University of Mato Grosso, Rua L s/n, Alvorada, 78000-000, Cuiaba, Brazil

    Diana B. Dock-Nascimento

Authors
  1. Marcelo S. M. Faria
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  2. José E. de Aguilar-Nascimento
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  3. Osvânio S. Pimenta
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  4. Luis C. Alvarenga Jr
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  5. Diana B. Dock-Nascimento
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  6. Natasha Slhessarenko
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Corresponding author

Correspondence to José E. de Aguilar-Nascimento.

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Faria, M.S.M., de Aguilar-Nascimento, J.E., Pimenta, O.S. et al. Preoperative Fasting of 2 Hours Minimizes Insulin Resistance and Organic Response to Trauma After Video-Cholecystectomy: A Randomized, Controlled, Clinical Trial. World J Surg 33, 1158–1164 (2009). https://doi.org/10.1007/s00268-009-0010-x

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