Preoperative Very Low-Calorie Diet and Operative Outcome After Laparoscopic Gastric Bypass: A Randomized Multicenter Study

• Published in: Archives of surgery (Chicago. 1960) Vol. 146; no. 11; pp. 1300 - 1305
• Main Authors: Van Nieuwenhove, Yves, Dambrauskas, Zilvinas, Campillo-Soto, Alvaro, van Dielen, Francois, Wiezer, René, Janssen, Ignace, Kramer, Michael, Thorell, Anders
• Format: Journal Article
• Language: English
• Published: Chicago, IL American Medical Association 01.11.2011
• Subjects: Adult; Biological and medical sciences; Caloric Restriction - methods; Diet; Digestive system. Abdomen; Endoscopy; Female; Follow-Up Studies; Gastric Bypass - methods; Gastrointestinal surgery; General aspects; Humans; Investigative techniques, diagnostic techniques (general aspects); Laparoscopy; Male; Medical sciences; Medicin och hälsovetenskap; Morbidity; Obesity; Obesity, Morbid - diet therapy; Obesity, Morbid - surgery; Postoperative Complications - prevention & control; Preoperative Care - methods; Prognosis; Prospective Studies; Single-Blind Method; Stomach, duodenum, intestine, rectum, anus; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases; Surgery of the digestive system; Weight control; Weight Loss - physiology; Sweden; Netherlands; Belgium; Lithuania; Spain; Medicine; Randomization; Prognosis; Multicenter study; Bariatric surgery; Evolution; Laparoscopy; Endoscopy; Preoperative; Very low calorie diet
• ISSN: 0004-0010; 2168-6254; 1538-3644; 1538-3644; 2168-6262
• DOI: 10.1001/archsurg.2011.273

HYPOTHESIS A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes. DESIGN Multicenter, randomized, single-blind study. SETTING Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium. PATIENTS Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010. INTERVENTION Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group). MAIN OUTCOME MEASURES 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.