Abstract
Background
Laparoscopic Roux-en-Y gastric bypass (LRYGB) may be a technically challenging surgical technique when features such as thick abdominal wall and increased liver volume are present. Very low calorie diets in the form of liquid meal replacements given 6 weeks prior to surgery have proven to decrease liver volume. The aim of our study was to assess the effect of a 6-week preoperative low calorie/regular diet on liver volume and body weight in morbidly obese patients.
Methods
A pilot study was carried out in 20 morbidly obese patients with an 800-kcal diet for 6 weeks. They were followed weekly to ensure proper compliance. CT scan was used for determining liver volume every 2 weeks in order to assess the impact of the diet. Baseline values were taken as controls for every patient as tied measures. Statistical analysis was suitable to variable scaling and performed using SPSS v. 20.0. Parametric and non-parametric test for tied measures were done. Any p value lesser than 0.05 or 5 % was considered as statistically significant.
Results
Twenty patients adhered to the diet intervention for 6 weeks prior to LRYGB. Median ± SD age was 34.5 ± 11.5 years and 17 were female (85 %). Heart rate and blood pressure did not vary across the study. Initial median ± SD BMI was 46.02 ± 5.29 kg/m2 (range 38.7–54.8). Repeated and tied measurements across the 6 weeks of treatment within individuals resulted statistically significant for reducing BMI (p < 0.0001). CT scan assessed liver volume initially as a control and in weeks 2, 4 and 6. Parametric and non-parametric assessment for multiple measurements also showed statistical significance among these values (p < 0.0001). Diet tolerability was additionally evaluated with a questionnaire showing more than 80 % of acceptability with discrete rates of nausea (15 %) and diarrhoea (15 %).
Conclusions
Based on our results, we demonstrated that a very low calorie diet with home ingredients is capable for effectively reducing body weight and liver size in morbidly obese patients. This relatively short intervention (4 to 6 weeks) was accomplished in all our patients with a high frequency of compliance and a low rate of secondary effects.
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References
Hedley AA, Orden CL, Jonson CL, et al. Prevalence of overweight and obesity among US children, adolescents, and adults, 1999–2004. JAMA. 2006;295(13):1549–55.
Fontaine KR, Redden DT, Wang C, et al. Years of life lost due to obesity. JAMA. 2003;289(2):187–93.
Del Gaudio A, Boschi L, Del Gaudio GA, et al. Liver damage in obese patients. Obes Surg. 2002;12:802–4.
Moretto M, Kupski C, Mottin CC, et al. Hepatic steatosis in patients undergoing bariatric surgery and its relationship to body mass index and co-morbidities. Obes Surg. 2003;13:622–24.
Buchwald H, Avidor Y, Braunwald E, et al. Bariatric surgery. A systematic review and meta-analysis. JAMA. 2004;292(14):1724–37.
Cottam DR, Atkinson J, Anderson A, et al. A case-controlled matched-pair cohort study of laparoscopic Roux-en-Y gastric bypass and lap-band patients in a single US center with three-year follow-up. Obes Surg. 2006;16:534–40.
Schauer P, Ikramuddin S, Hamad G, et al. The learning curve for laparoscopic Roux-en-Y gastric bypass is 100 cases. Surg Endosc. 2003;17:212–5.
Podnos YD, Jiménez JC, Wilson SE, et al. Complications alter laparoscopic gastric bypass. Arch Surg. 2003;138:957–61.
Liu RC, Adheesh AS, Rorsyth C, et al. The effects of acute preoperative weight loss on laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1396–402.
Alvarado R, Alami RS, Hsu G, et al. The impact of preoperative weight loss in patients undergoing laparoscopic Roux-en-Y gastric bypass. Obes Surg. 2005;15:1282–6.
Fris RJ. Preoperative low energy diet diminishes liver size. Obes Surg. 2004;14:1165–70.
Lewis MC, Philips ML, Slavotinek JP, et al. Change in liver size and fat content after treatment with Optifast very low calorie diet. Obes Surg. 2006;16:697–701.
Colles SL, Dixon JB, Marks P, et al. Preoperative weight loss with a very-low energy diet: quantitation of changes in liver and abdominal fat by serial imaging. Am J Clin Nutr. 2006;84:304–11.
Van Nieuwenhove Y, Dambrauskas Z, Campillo-Soto A, et al. Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass. Arch Surg. 2011;146(11):1300–5.
Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21:345–50.
Frutos MD, Morales MD, Luján J, et al. Intragastric balloon reduces liver volume in super-obese patients, facilitating subsequent laparoscopic gastric bypass. Obes Surg. 2007;17(2):150–4.
Schiano TD, Bodian C, Schwartz ME, et al. Accuracy and significance of computed tomographic scan assessment of hepatic volume in patients undergoing liver transplantation. Transplantation. 2000;69(4):545–50.
Urata K, Matsunami H, Hashikura Y, et al. Calculation of child and adult standard liver volume for liver transplantation. Hepatology. 1995;21:1317–21.
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The authors of this manuscript declare no conflict of interest regarding any commercial label or pharmaceutical industry.
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González-Pérez, J., Sánchez-Leenheer, S., Delgado, A.R. et al. Clinical Impact of a 6-Week Preoperative Very Low Calorie Diet on Body Weight and Liver Size in Morbidly Obese Patients. OBES SURG 23, 1624–1631 (2013). https://doi.org/10.1007/s11695-013-0977-0
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DOI: https://doi.org/10.1007/s11695-013-0977-0