Stenberg Erik, Laurenius Anna, Thorell Anders
Department of Surgery, Faculty of Medicine and Health, Örebro University, Örebro, Sweden.
Institute of Clinical Sciences, Department of Surgery, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden; Department of Gastroenterology and Hepatology, Sahlgrenska University Hospital, Gothenburg, Sweden.
Clin Nutr. 2025 Feb;45:156-164. doi: 10.1016/j.clnu.2025.01.008. Epub 2025 Jan 10.
Obesity may increase complexity of surgical procedures and increase the risk of perioperative complications. Weight reduction by the use of low energy diet (LED, ≤1200 kcal/day) or very low energy diet (VLED, ≤800 kcal/day) can reduce postoperative complications after bariatric surgery, but for most other types of surgery the evidence for its use remains uncertain. The aim of this systematic review was therefore to evaluate the scientific evidence in general for this routine.
The Medline, Embase, Web of Science and Cochrane databases were searched up until November 20, 2024 using the Cochrane risk of bias assessment tool for observational studies and the NIH quality assessment of controlled intervention studies for randomized trials. Operation time, surgeon's perceived difficulty, intraoperative complications, postoperative complications and relevant efficacy measures for specific procedures were considered as endpoints. A random-effects model was used to pool effect sizes for the main analyses.
A total of 7053 studies were identified. After screening by title and abstract, followed by full text, 18 studies (9 RCTs and 9 observational studies) remained for the analyses including 854 patients who received the intervention and 979 controls. Preoperative LED/VLED resulted in an overall shorter operation time (standard mean difference 0.36, 95 % CI 0.14-0.59, p = 0.002), and reduced risk of postoperative complications after bariatric surgery, cholecystectomy, colorectal surgery and hernia repair (pooled RR 0.63, 95%CI 0.51-0.79, p < 0.001). Heterogeneity between studies was high for operation time but very low for complications. No difference was seen for intraoperative complications, while the data did not allow further analyses on perceived difficulty of surgery or efficacy outcomes.
The results support the use of LED/VLED for short-term preoperative weight reduction in patients with obesity planned for bariatric surgery and for those undergoing cholecystectomy, colorectal surgery and hernia repair. Further studies including a comparable control group are needed to evaluate its routine use for other surgical procedures.
The protocol of this study was preregistered at the International Prospective Register of Systematic Reviews, PROSPERO.
肥胖可能会增加手术操作的复杂性，并增加围手术期并发症的风险。采用低能量饮食（LED，≤1200千卡/天）或极低能量饮食（VLED，≤800千卡/天）减轻体重可降低减肥手术后的术后并发症，但对于大多数其他类型的手术，其使用证据仍不明确。因此，本系统评价的目的是评估这一常规做法的总体科学证据。
截至2024年11月20日，使用Cochrane观察性研究偏倚风险评估工具和美国国立卫生研究院随机试验对照干预研究质量评估工具对Medline、Embase、科学网和Cochrane数据库进行检索。手术时间、外科医生感知的难度、术中并发症、术后并发症以及特定手术的相关疗效指标被视为终点。主要分析采用随机效应模型合并效应量。
共确定了7053项研究。经标题和摘要筛选，随后进行全文筛选，18项研究（9项随机对照试验和9项观察性研究）纳入分析，包括854例接受干预的患者和979例对照。术前LED/VLED导致总体手术时间缩短（标准均差0.36，95%置信区间0.14 - 0.59，p = 0.002），并降低了减肥手术、胆囊切除术、结直肠手术和疝修补术后的术后并发症风险（合并相对危险度0.63，95%置信区间0.51 - 0.79，p < 0.001）。研究间手术时间的异质性较高，但并发症的异质性非常低。术中并发症未见差异，而数据不允许对手术感知难度或疗效结果进行进一步分析。
结果支持对计划进行减肥手术的肥胖患者以及接受胆囊切除术、结直肠手术和疝修补术的患者，术前使用LED/VLED进行短期体重减轻。需要进一步开展包括可比对照组的研究，以评估其在其他手术中的常规应用。
本研究方案已在国际前瞻性系统评价注册库PROSPERO预注册。
