Preoperative very low calorie diet reduces technical difficulty during laparoscopic cholecystectomy in obese patients
Since 1993 in the UK, prevalence of adult obesity has risen from 15% to 25%. Obesity is associated with cholelithiasis, and symptomatic gallstones are a major burden on the health service. Preoperative very low calorie diet [VLCD] is known to reduce technical difficulty and post operative complications in bariatric surgery. Its effectiveness has not been investigated in laparoscopic cholecystectomy.
A prospective observational study of consecutive patients undergoing laparoscopic cholecystectomy was undertaken. At the pre-operative visit, all patients were advised to adhere to VLCD for two weeks prior to surgery. Surgeons were blinded as to whether patients had complied with the VLCD. Technical difficulty was assessed on Likert scale, closed questions and visual analogue scales. Statistical analysis was by Fisher’s Exact test for categorical variables and Mann-Whitney test for continuous variables, as appropriate.
Of 38 patients, 33 [87%] were female, median age was 45 years [range 19 to 76 years], median BMI was 30.3 kg/m2 [range 22.5-44.1], 19/38 [50%] were obese. A total of 13/38 [34%] patients adhered to the VLCD. 6/19 [32%] of obese patients adhered to the VLCD.
In 8 operations involving obese patients there was difficulty in either retracting the liver, displaying Calot’s triangle or the liver obscuring view. All of these patients involved VLCD non-compliant patients [p0.018].
Adherence to a 2-week preoperative VLCD appears to reduce technical difficulty of laparoscopic cholecystectomy in obese patients.