Mohamed AbdAlla Salman1, Mohamed Gamal Qassem2, Mohamed Saad Aboul-Enein3, Mahmoud A Ameen4, Ahmed Abdallah4, Hitham Omar4, Ahmed Mahmoud Hussein4, Mohamed Sabry Tourky5, Khaled Monazea6, Ahmed M Hassan6, Ahmed Salman7, Ahmed Moustafa8, Hossam El-Din Shaaban9, Ahmed Soliman10, Mohamed D Sarhan4. 1. General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. Mohammed.salman@kasralainy.edu.eg. 2. General Surgery Department, Ain Shams University, Cairo, Egypt. 3. Lecturer of General Surgery, Faculty of Medicine, Tanta University, Tanta, Egypt. 4. General Surgery Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. 5. Great Western Hospital Foundation NHS Trust, General Surgery, Swindon, UK. 6. General Surgery Department, Faculty of Medicine for Boys- Assiut Branch, Alazhar University, Assiut, Egypt. 7. Internal Medicine Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. 8. Endemic Medicine and Hepatology Department, Kasralainy School of Medicine, Cairo University, Cairo, Egypt. 9. National Hepatology and Tropical Medicine Research Institute, Gastroenterology and Hepatology, Cairo, Egypt. 10. Senior Clinical Fellow Endocrinology and Diabetes, Lancashire Teaching Hospital, NHS Foundation Trust, Preston, UK.
Abstract
BACKGROUND: Low caloric diet can reduce liver volume; however, there is no consensus regarding preoperative weight reduction before bariatric surgery. This study evaluates the effect of preoperative very-lowcalorie diet (VLCD) in patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: This prospective study included patients scheduled for LSG stratified into two groups, Diet Group (n = 183) who followed a preoperative VLCD regimen for three weeks and underwent assessment of the liver lobes span before and after regimen, and Control Group (n = 138) who underwent sonographic assessment once before surgery and were operated upon without diet. The outcome measures were the impact of preoperative diet on the liver span, intraoperative complications, anthropometric factors affecting the liver span. RESULTS: Diet regimen resulted in a significant reduction of the right and left lobes. The percentage of the reduction of the left lobe span was significantly higher than that of the right lobe (p < 0.001). Change of the size of the two lobes was correlated positively with weight and body mass index and initial size of both lobes. There was no significant difference between the two groups in the frequency of operative complications. CONCLUSION: VLCD for three weeks before bariatric surgery effectively reduced liver size. The reduction is more in the left lobe. The changes of both lobes were correlated well with the pre- and post-regimen weight and BMI. It was also positively correlated with the initial size of both lobes.
BACKGROUND: Low caloric diet can reduce liver volume; however, there is no consensus regarding preoperative weight reduction before bariatric surgery. This study evaluates the effect of preoperative very-lowcalorie diet (VLCD) in patients undergoing laparoscopic sleeve gastrectomy (LSG). METHODS: This prospective study included patients scheduled for LSG stratified into two groups, Diet Group (n = 183) who followed a preoperative VLCD regimen for three weeks and underwent assessment of the liver lobes span before and after regimen, and Control Group (n = 138) who underwent sonographic assessment once before surgery and were operated upon without diet. The outcome measures were the impact of preoperative diet on the liver span, intraoperative complications, anthropometric factors affecting the liver span. RESULTS: Diet regimen resulted in a significant reduction of the right and left lobes. The percentage of the reduction of the left lobe span was significantly higher than that of the right lobe (p < 0.001). Change of the size of the two lobes was correlated positively with weight and body mass index and initial size of both lobes. There was no significant difference between the two groups in the frequency of operative complications. CONCLUSION: VLCD for three weeks before bariatric surgery effectively reduced liver size. The reduction is more in the left lobe. The changes of both lobes were correlated well with the pre- and post-regimen weight and BMI. It was also positively correlated with the initial size of both lobes.