Evaluating the evidence for a liver shrinkage diet for obese patients prior to laparoscopic cholecystectomy: A systematic review and meta-analysis

Daniel Llwyd Hughes; Mohamed Elmasry; Iain Wilson; Jihène El Kafsi

doi:10.4103/jmas.jmas_142_23

Evaluating the evidence for a liver shrinkage diet for obese patients prior to laparoscopic cholecystectomy: A systematic review and meta-analysis

J Minim Access Surg. 2024 Jan 1;20(1):1-6. doi: 10.4103/jmas.jmas_142_23. Epub 2024 Jan 13.

Authors

Daniel Llwyd Hughes¹, Mohamed Elmasry², Iain Wilson¹, Jihène El Kafsi¹

Affiliations

¹ Department of UGI Surgery, Wexham Park Hospital, Frimley Health NHS Foundation Trust, England, UK.
² Department of HPB Surgery, Churchill Hospital, Oxford Health NHS Foundation Trust, Oxford, UK.

Abstract

Background: The role of a very low-calorie diet (VLCD) before cholecystectomy in obese patients is unclear. This study evaluated whether VLCD could be used as a risk mitigation strategy for this high-risk patient cohort.

Patients and methods: A systematic review and meta-analysis was performed (PROSPERO ID CRD42022374610). The primary outcome was to determine the impact of pre-operative VLCD on the operative findings and ease of dissection during laparoscopic cholecystectomy (LC).

Results: Two studies were included with a total of 84 patients. VLCD was associated with a significantly easier Calot's dissection (MD: -0.58 (95% confidence interval [CI] [ -1.03, -0.13], P = 0.01) and was associated with a significantly higher rate of pre-operative weight loss (MD; 2.92 (95% CI [2.23, 3.62], P = 0.00001).

Conclusions: The published evidence regarding VLCD before cholecystectomy in obese patients is limited. After acknowledging the limitations of the data, VLCD is associated with a significantly higher rate of weight loss preoperatively and directly impacts the ease of intraoperative dissection of Calot's triangle. Routine use of VLCD should be considered for all obese patients undergoing elective LC.