Van Nieuwenhove Yves, Dambrauskas Zilvinas, Campillo-Soto Alvaro, van Dielen Francois, Wiezer René, Janssen Ignace, Kramer Michael, Thorell Anders
Department of Gastrointestinal Surgery, University Hospital Ghent, De Pintelaan 185, 9000 Ghent, Belgium.
Arch Surg. 2011 Nov;146(11):1300-5. doi: 10.1001/archsurg.2011.273.
A 14-day very low-calorie diet (VLCD) regimen before a laparoscopic gastric bypass procedure will improve perioperative and postoperative outcomes.
Multicenter, randomized, single-blind study.
Five high-volume bariatric centers in Sweden, the Netherlands, Lithuania, Spain, and Belgium.
Two hundred ninety-eight morbidly obese patients undergoing laparoscopic gastric bypass from March 1, 2009, through December 5, 2010.
Patients were randomly allocated to a 2-week preoperative VLCD regimen or no preoperative dietary restriction (control group).
Operating time, surgeon's perceived difficulty of the operation, liver lacerations, intraoperative bleeding and complications, 30-day weight loss, and morbidity.
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).
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.
在腹腔镜胃旁路手术前采用为期14天的极低热量饮食（VLCD）方案将改善围手术期和术后结局。
多中心、随机、单盲研究。
瑞典、荷兰、立陶宛、西班牙和比利时的五个大型减肥中心。
298例病态肥胖患者，于2009年3月1日至2010年12月5日接受腹腔镜胃旁路手术。
患者被随机分配至术前为期2周的VLCD方案组或无术前饮食限制组（对照组）。
手术时间、外科医生感知的手术难度、肝裂伤、术中出血及并发症、30天体重减轻情况和发病率。
VLCD组术前平均（标准差）体重变化为-4.9（3.6）kg，而对照组为-0.4（3.2）kg（P <.001）。虽然VLCD组外科医生感知的手术难度较低（视觉模拟量表上的中位数[四分位间距]，26[15 - 42]对35[18 - 50]mm；P = 0.04），但在平均（标准差）手术时间（81[21]对80[23]分钟；P = 0.53）、估计失血量（P = 0.62）或术中并发症方面未发现差异（P = 0.88）。在30天随访时，对照组的并发症数量多于VLCD组（18对8；P = 0.04）。
虽然在大型中心进行腹腔镜胃旁路手术前采用为期14天的VLCD方案减轻体重似乎降低了手术的感知难度，但预计对手术时间、术中并发症和短期体重减轻只有轻微影响。然而，术后并发症发生率降低这一发现表明，在减肥手术前应推荐采用这样的方案。
