Preoperative Very Low-Calorie Diet Reduces Technical Difficulty During Laparoscopic Cholecystectomy in Obese Patients.
This study investigates the effectiveness of preoperative very low-calorie diet (VLCD) in laparoscopic cholecystectomy. A prospective observational study of consecutive patients undergoing laparoscopic cholecystectomy was undertaken. At the preoperative visit, all patients were advised to adhere to VLCD for 2 weeks before surgery (<800 kcal/d). Patients were judged to have complied with the VLCD if weight loss >2 kg. Technical difficulty was assessed using questionnaires. A total of 38 patients met the inclusion criteria. Difficulty of visualization and dissection of Calot's triangle in obese patients was twice that of nonobese patients (P=0.01). In 62% of procedures involving obese VLCD noncompliant patients, the surgeon experienced ≥1 area of technical difficulty, compared with 0% of procedures on obese, compliant patients (P=0.018). Difficulty of dissection of the gallbladder bed was 3 times higher in obese, noncompliant patients, compared with obese, compliant patients (P=0.07). Adherence to a 2-week preoperative VLCD may reduce technical difficulty of laparoscopic cholecystectomy in obese patients.
Department of Surgery, Heart of England NHS Foundation Trust, Bordesley Green East, Birmingham, UK.
Alexander D
AD
Jones
Peter W
PW
Waterland
Sarah
S
Powell-Brett
Paul
P
Super
Martin
M
Richardson
Douglas
D
Bowley
D000328:Adult; D000368:Aged; D001660:Biliary Tract Diseases / Q000601:surgery; D031204:Caloric Restriction / Q000379:methods*; D017081:Cholecystectomy, Laparoscopic / Q000379:methods*; D003085:Colic / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009765:Obesity / Q000178:diet therapy / Q000503:physiopathology / Q000601:surgery*; D010349:Patient Compliance; D011300:Preoperative Care / Q000379:methods; D011446:Prospective Studies; D015431:Weight Loss / Q000502:physiology; D055815:Young Adult