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Very Low Calorie Diet before Laparoscopic Cholecystectomy
Chicago—Obese patients who went on a very low calorie diet for 2 weeks prior to undergoing a laparoscopic cholecystectomy procedure had a significant decrease in body weight and operation time compared with a group that continued their normal diet, according to a randomized, single-blind, single-center study. Nicholas Burr, MD, the study’s lead author, presented the results during a scientific session at DDW.
Dr. Burr noted that up to 35% of obese patients have nonalcoholic fatty liver disease, and he added that a fatty liver makes laparoscopic cholecystectomy more difficult. He also mentioned that studies have indicated that a very low calorie diet leads to a 22% liver volume reduction and also decreases liver glycogen stores and steatosis. A very low calorie diet is now commonly used before bariatric surgery, according to Dr. Burr.
This study included 46 patients who were 18 to 70 years of age, had a body mass index >30 kg/m2, and had elective cholecystectomy. They were excluded if they had previous abdominal surgery, common bile duct stones, diabetes, or liver disease. Dr. Burr explained that the researchers excluded diabetic patients because the very low calorie diet was not appropriate for them.
Patients were randomized to have a normal diet (n=21) or a very low calorie diet (n=25), which consisted of 500 to 800 calories per day for 2 weeks prior to surgery. At baseline, the groups were well-balanced.
The mean weight loss in the 2 weeks before the procedure was 3.5 kg in the very low calorie diet group and 0.9 kg in the normal group (P<.0001). The mean operation time was 25 minutes in the very low calorie diet group and 31 minutes in the normal group (P<.005).
The median length of stay in the hospital was 10.5 hours in the very low calorie diet group and 13.7 hours in the normal group, which was not a significant difference. There were 2 complications in the normal group (an open conversion and bile leak), while the very low calorie diet group only had 1 complication: port hematoma.
“The hypothesis for why there was a reduction in the operation time was the liver was more easily displaced during the operation and Calot’s triangle was easily displayed in the patients who had a very low calorie diet,” Dr. Burr said.
Dr. Burr said that larger studies are needed to replicate the work and determine if the operation time reduction results in improved clinical outcomes, such as complication rates from the surgery.
