Effect of preoperative diet regimen on liver size before laparoscopic sleeve gastrectomy in morbidly obese patients.

Background: Low caloric diet can reduce liver volume; however, there is no consensus regarding preoperative weight reduction before bariatric surgery. This study evaluates the effect of preoperative very-lowcalorie diet (VLCD) in patients undergoing laparoscopic sleeve gastrectomy (LSG).

Methods: This prospective study included patients scheduled for LSG stratified into two groups, Diet Group (n = 183) who followed a preoperative VLCD regimen for three weeks and underwent assessment of the liver lobes span before and after regimen, and Control Group (n = 138) who underwent sonographic assessment once before surgery and were operated upon without diet. The outcome measures were the impact of preoperative diet on the liver span, intraoperative complications, anthropometric factors affecting the liver span.

Results: Diet regimen resulted in a significant reduction of the right and left lobes. The percentage of the reduction of the left lobe span was significantly higher than that of the right lobe (p < 0.001). Change of the size of the two lobes was correlated positively with weight and body mass index and initial size of both lobes. There was no significant difference between the two groups in the frequency of operative complications.

Conclusion: VLCD for three weeks before bariatric surgery effectively reduced liver size. The reduction is more in the left lobe. The changes of both lobes were correlated well with the pre- and post-regimen weight and BMI. It was also positively correlated with the initial size of both lobes.