|
Back to 2014 Annual Meeting Abstracts
A Randomised, Single-Blinded Trial Assessing the Effect of a Two Week Preoperative Very Low Calorie Diet on Laparoscopic Cholecystectomy Procedure in Obese Patients
Nicholas Burr*, Katherine Burnand, Rajiv Lahiri, John M. Bennett, Michael P. Lewis
Upper Gastrointestinal Surgery, Norfolk and Norwich University hospital, Norwich, United Kingdom
Background - A very low calorie diet (VLCD) before bariatric surgery has been shown to decrease liver volume and improve laparoscopic operative access and is often a routine part of the preoperative workup for bariatric procedures. During laparoscopic cholecystectomy the effect of a VLCD could ease dissection of the gall bladder, improve operative views and reduce hepatic bleeding from surgical trauma. The aims of this study were to investigate whether a 2 week calorie restricted diet before surgery can reduce operative time and post-operative complications. The primary outcome measure was operation time. Secondary outcomes were length of stay, operative complications and day case rates.
Methods - Patients with BMI >30kg/m2, aged between 18-70 years with symptomatic gallstone disease attending for elective laparoscopic cholecystectomy at the Norfolk and Norwich University Hospital, UK were invited to take part in the study. Patients were recruited between May 2011 and May 2013. Exclusion criteria were previous abdominal surgery, common bile duct stones, type I or type II diabetes mellitus and liver disease. Patients were randomised at pre-assessment to a VLCD or normal diet for two weeks prior to cholecystectomy. Comprehensive food diaries were used to document dietary intake in both groups. A single surgeon, blind to the intervention group, performed all operations. An a priori power calculation determined that 23 patients were required in each group to detect a clinically significant difference in operation time of 2.5 minutes at 80% power with 95% confidence intervals.
Results - 21 cases and 25 controls were recruited into the study. One patient (control group) withdrew and was analysed on an intention to treat (ITT) basis. There was no significant difference in age, gender, BMI and co-morbidity between the study groups. The VLCD was well tolerated and resulted in a mean weight loss difference of 2.5 kg (95% CI, 1.4-3.6) compared to normal diet. There was a significant reduction in median operative time of 6 minutes (p=0.004) for patients taking the VLCD compared to controls (25 minutes (range 18-40.5 minutes) versus 31 minutes (20-170)). There were no differences in secondary outcome measures (complication rate, length of stay, or day case rates) between the groups.
Discussion - This is the first study to investigate the use of VLCD before laparoscopic cholecystectomy in obese patients. The key finding was a statistically significant reduction in operation time for the intervention group (p=0.004). Low calorie diet can be offered to patients before cholecystectomy as a safe, well tolerated intervention to reduce operative time but also to reduce weight and thus protect against future weight related morbidity.
Back to 2014 Annual Meeting Abstracts
|
