Department of Radiology, University Hospitals Plymouth NHS Trust, Derriford Hospital, Derriford Road, Plymouth, England, PL6 8DH, UK.
Department of HPB Surgery, University Hospitals Plymouth NHS Trust, Derriford Road, Plymouth, England, PL6 8DH, UK.
Langenbecks Arch Surg. 2024 Oct 28;409(1):327. doi: 10.1007/s00423-024-03509-3.
The use of pre-operative very low-calorie diets (VLCD) is established within bariatric and gallbladder surgery. However, their use in patients with high BMI and hepatic steatosis (HS) requiring upper abdominal procedures is unclear. This review aims to assess the safety, adherence, and outcomes of a pre-operative VLCD prior to non-bariatric elective surgery.
A systematic search on PubMed MEDLINE, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL and AMED was performed to identify the included studies. Studies were included, if they administered a VLCD to patients undergoing non-bariatric elective surgery and reported on outcomes.
Eight studies were included in this review and all administered a VLCD through either dietician led diet plans or meal replacement shakes. The adherence to the VLCD was heterogeneously measured but was excellent overall with a good safety profile. The VLCD was able to significantly reduce HS and resulted in a less technically difficult operation with reduced intra-operative blood loss. There was no significant impact on intraoperative or early post-operative outcomes.
This review highlights that a VLCD can be administered safely during the pre-operative period and overall adherence is excellent, however heterogeneously measured. There was an overall positive impact on reducing hepatic steatosis, operative difficulty and intraoperative blood loss, however no significant impact on overall morbidity and mortality.
极低热量饮食（VLCD）在减重和胆囊手术中已得到广泛应用。然而，对于需要进行上腹部手术的高 BMI 和肝脂肪变性（HS）患者，其应用效果尚不清楚。本综述旨在评估术前 VLCD 在非减重择期手术中的安全性、依从性和结局。
我们在 PubMed MEDLINE、Embase、Cochrane 对照试验中心注册库（CENTRAL）、CINAHL 和 AMED 上进行了系统检索，以确定纳入的研究。如果研究将 VLCD 用于非减重择期手术患者，并报告了结局，则将其纳入。
本综述纳入了 8 项研究，所有研究均通过营养师指导的饮食计划或代餐奶昔来实施 VLCD。VLCD 的依从性测量存在异质性，但总体上非常好，安全性良好。VLCD 可显著降低 HS，并使手术操作更简单，术中出血量减少。VLCD 对术中或术后早期结局无显著影响。
本综述表明，VLCD 可在术前安全使用，总体依从性良好，但测量存在异质性。VLCD 对降低肝脂肪变性、手术难度和术中出血量有积极影响，但对总体发病率和死亡率无显著影响。
