title: Preoperative very low-calorie diet and operative outcome after laparoscopic gastric bypass: a randomized multicenter study.
abstract: OBJECTIVE
  A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes.
  
  
  METHODS
  Multicenter, randomized, single-blind study.
  
  
  METHODS
  Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium.
  
  
  METHODS
  Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010.
  
  
  METHODS
  Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group).
  
  
  METHODS
  Operating time, surgeon's perceived difficulty of the operation, liver lacerations, intraoperative bleeding and complications, 30-day weight loss, and morbidity.
  
  
  RESULTS
  Mean (SD) preoperative weight change was -4.9 (3.6) kg in the VLCD group vs -0.4 (3.2) kg in the control group (P < .001). Although the surgeon's perceived difficulty of the procedure was lower in the VLCD group (median [interquartile range], 26 [15-42] vs 35 [18-50] mm on a visual analog scale; P = .04), no differences were found regarding mean (SD) operating time (81 [21] vs 80 [23] min; P = .53), estimated blood loss (P = .62), or intraoperative complications (P = .88). At the 30-day follow-up, the number of complications was greater in the control compared with the VLCD group (18 vs 8; P = .04).
  
  
  CONCLUSIONS
  Although weight reduction with a 14-day VLCD regimen before laparoscopic gastric bypass performed in high-volume centers seems to reduce the perceived difficulty of the procedure, only minor effects on operating time, intraoperative complications, and short-term weight loss could be expected. However, the finding of reduced postoperative complication rates suggests that such a regimen should be recommended before bariatric surgery.
authors: Department of Gastrointestinal Surgery, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium. yves.vannieuwenhove@ugent.be
authors: Yves
authors: Y
authors: Van Nieuwenhove
authors: Zilvinas
authors: Z
authors: Dambrauskas
authors: Alvaro
authors: A
authors: Campillo-Soto
authors: Francois
authors: F
authors: van Dielen
authors: René
authors: R
authors: Wiezer
authors: Ignace
authors: I
authors: Janssen
authors: Michael
authors: M
authors: Kramer
authors: Anders
authors: A
authors: Thorell
mesh_terms: D000328:Adult; D031204:Caloric Restriction / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D015390:Gastric Bypass / Q000379:methods*; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000178:diet therapy / Q000601:surgery*; D011183:Postoperative Complications / Q000517:prevention & control; D011300:Preoperative Care / Q000379:methods*; D011379:Prognosis; D011446:Prospective Studies; D016037:Single-Blind Method; D015431:Weight Loss / Q000502:physiology*