Division of General and Thoracic Surgery, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA.
Surg Obes Relat Dis. 2011 Jul-Aug;7(4):480-5. doi: 10.1016/j.soard.2010.09.026. Epub 2010 Nov 9.
Superobesity, through organomegaly, excessive adiposity, and associated severe co-morbidities, is a recognized risk factor for bariatric surgery. Our study examined the utility of preoperative weight loss with a liquid low-calorie diet (LCD) as a method of risk reduction.
All patients with a body mass index (BMI) >50 kg/m(2) were instructed to consume a LCD (800 kcal/d) with the goal of losing ≥10% of their body weight. The co-morbidities were monitored. The abdominal wall depth and cross-sectional areas of subcutaneous adipose tissue (SAT) at 12 and 20 cm below the costal margin, visceral adipose tissue (VAT), and liver volume were measured, using computed tomography, at baseline and after completion of the LCD. Laparoscopic gastric bypass was performed in all patients.
The study included 30 patients (27 men and 3 women) with a mean age of 53 years (range 34-53). The mean BMI was reduced from 56 kg/m(2) (range 50-69) at baseline to 49 kg/m(2) (range 43-60) after an average of 9 weeks of the LCD. The VAT decreased from a mean of 388 cm(2) to 342 cm(2). The abdominal wall depth decreased from 3.6 to 3.2 cm at 12 cm below the costal margin and from 3.7 to 3.4 cm at 20 cm. The mean SAT at both 12 and 20 cm below the costal margin had decreased from 577 cm(2) and 687 cm(2) to 509 cm(2) and 614 cm(2), respectively. The liver volume was reduced by 18%. All co-morbidities were well controlled at LCD completion. No patient died, and 2 minor complications occurred postoperatively.
The results of our study have shown that preoperative LCD is a safe and effective tool leading to a significant decrease in liver volume and abdominal wall depth, as well as a reduction in both VAT and SAT. Its use might contribute to improved short-term surgical outcomes in high-risk superobese patients.
超级肥胖通过器官肿大、过多的脂肪堆积和相关的严重合并症，是减重手术的一个公认的危险因素。我们的研究检查了术前通过液体低热量饮食（LCD）减轻体重作为一种降低风险的方法的效果。
所有 BMI 大于 50kg/m²的患者都被指示食用 LCD（800kcal/d），目标是减轻其体重的 10%。监测合并症。使用 CT 测量基线时和完成 LCD 后的肋缘下 12cm 和 20cm 处的皮下脂肪组织（SAT）、内脏脂肪组织（VAT）和肝体积的腹壁深度和横截面积。所有患者均行腹腔镜胃旁路手术。
研究包括 30 名患者（27 名男性和 3 名女性），平均年龄为 53 岁（范围 34-53 岁）。BMI 从基线时的 56kg/m²（范围 50-69）平均降低到 LCD 后 9 周时的 49kg/m²（范围 43-60）。VAT 从平均 388cm²减少到 342cm²。腹壁深度从肋缘下 12cm 处的 3.6cm 减少到 3.2cm，从肋缘下 20cm 处的 3.7cm 减少到 3.4cm。肋缘下 12cm 和 20cm 处的 SAT 平均值分别从 577cm²和 687cm²减少到 509cm²和 614cm²。肝体积减少了 18%。LCD 完成时所有合并症均得到良好控制。无患者死亡，术后发生 2 例轻微并发症。
我们的研究结果表明，术前 LCD 是一种安全有效的工具，可显著降低肝体积和腹壁深度，以及减少 VAT 和 SAT。它的使用可能有助于改善高危超级肥胖患者的短期手术结果。
