College of Medicine & Public Health, Flinders University, Bedford Park, SA, Australia.
Adelaide Gastrointestinal Specialists, Eastwood, SA, Australia.
Surg Endosc. 2024 Aug;38(8):4171-4185. doi: 10.1007/s00464-024-11016-1. Epub 2024 Jul 8.
Obesity may increase surgical complexity in patients undergoing abdominal surgery by limiting visualization and increasing the risk of peri-operative complications. A preoperative reduction in weight and liver volume may improve surgical outcomes. The aim of our study was to evaluate the efficacy of a low-calorie diet (LCD) versus a very low-calorie diet (VLCD) in reducing weight and liver volume prior to laparoscopic surgery.
A systematic search was conducted using the following inclusion criteria: obese patients undergoing preoperative weight loss using a VLCD or LCD, evaluation of liver volume reduction, and the use of an imaging modality before and after the diet.
A total of 814 patients from 21 different studies were included in this systematic review and meta-analysis, with 544 female patients (66.8%) and a mean age range between 24 and 54 years old. There was a total mean weight loss of 6.42% and mean liver volume reduction of 16.7%. Meta-analysis demonstrated that a preoperative diet (LCD or VLCD) significantly reduced weight [SMD = - 0.68; 95% CI (- 0.93, - 0.42), I = 82%, p ≤ 0.01] and liver volume [SMD = - 2.03; 95% CI (- 4.00, - 0.06), I = 94%, p ≤ 0.01]. When assessed individually, a VLCD led to significant weight reduction [SMD = - 0.79; CI (- 1.24; - 0.34), p ≤ 0.01, I = 90%], as did an LCD [SMD = - 0.60; CI (- 0.90; - 0.29), p ≤ 0.01, I = 68%). Similarly, there was a significant reduction in liver volume following a VLCD [SMD = - 1.40; CI (- 2.77, - 0.03), p ≤ 0.01, I = 96%], and an LCD [SMD = - 2.66; CI (- 6.13, 0.81), p ≤ 0.01, I = 93%]. However, there was no significant difference between the two regimens.
Preoperative restrictive calorie diets are effective in reducing weight and liver volume prior to laparoscopic surgery. Whilst a VLCD was better than an LCD at reducing both weight and liver volume, the difference was not significant.
肥胖可能会通过限制手术视野和增加围手术期并发症的风险来增加接受腹部手术的患者的手术复杂性。术前减轻体重和肝体积可能会改善手术结果。我们的研究目的是评估低热量饮食（LCD）与极低热量饮食（VLCD）在腹腔镜手术前减轻体重和肝体积的效果。
使用以下纳入标准进行系统搜索：使用 VLCD 或 LCD 进行术前减肥的肥胖患者，评估肝体积减少，并在饮食前后使用成像方式。
本系统评价和荟萃分析共纳入了 21 项不同研究的 814 名患者，其中 544 名女性患者（66.8%），平均年龄在 24 岁至 54 岁之间。总体平均体重减轻 6.42%，平均肝体积减少 16.7%。荟萃分析表明，术前饮食（LCD 或 VLCD）可显著减轻体重[SMD=-0.68；95%CI（-0.93，-0.42），I=82%，p≤0.01]和肝体积[SMD=-2.03；95%CI（-4.00，-0.06），I=94%，p≤0.01]。当单独评估时，VLCD 可显著减轻体重[SMD=-0.79；CI（-1.24；-0.34），p≤0.01，I=90%]，LCD 也是如此[SMD=-0.60；CI（-0.90；-0.29），p≤0.01，I=68%]。同样，VLCD 后肝体积显著减少[SMD=-1.40；CI（-2.77，-0.03），p≤0.01，I=96%]，而 LCD 后也显著减少[SMD=-2.66；CI（-6.13，0.81），p≤0.01，I=93%]。然而，两种方案之间没有显著差异。
术前限制热量的饮食可有效降低腹腔镜手术前的体重和肝体积。虽然 VLCD 在减轻体重和肝体积方面优于 LCD，但差异无统计学意义。
