TY - JOUR
T1 - Preoperative liver shrinking diet for bariatric surgery may impact wound healing
T2 - a randomized controlled trial
AU - Chakravartty, Saurav
AU - Vivian, Gillian
AU - Mullholland, Nicola
AU - Shaikh, Hizbullah
AU - McGrath, John
AU - Sidhu, Paul S.
AU - Jaffer, Ounali
AU - Patel, Ameet G.
N1 - Publisher Copyright:
© 2018
PY - 2019/1
Y1 - 2019/1
N2 - Background: In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner. Objective: This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass. Setting: University hospital. Methods: The trial was undertaken in patients undergoing laparoscopic Roux-en-Y gastric bypass, with a control group (n = 10) on normal diet and an intervention group (n = 10) on VLCD (800 kcal) for 4 weeks. The primary outcome measured was expression of collagen I and III in skin wounds, with biopsies taken before and after the diet and 7 days postoperatively as a surrogate of anastomotic healing. Secondary outcome measures included liver volume and fibrosis score, body composition, operating time, blood loss, hospital stay, and complications. Results: Patients in both groups were similar in age, sex, body mass index (53.4 versus 52.8 kg/m 2 ), co-morbidities, liver volume, and body composition. Expression of mature collagen type I was significantly decreased in diet patients compared with controls after 4 weeks of diet and 7 days after surgery. This was significant decrease in liver volume (23% versus 2%, P =.03) but no difference in operating times (129 versus 139 min, P =.16), blood loss, length of stay, or incidence of complications. Conclusions: Preoperative diets shrink liver volume and decrease expression of mature collagen in wounds after surgery. Whether the latter has a detrimental effect on clinical outcomes requires further evaluation.
AB - Background: In bariatric surgery, preoperative very low-calorie diets (VLCD) may better meet the technical demands of surgery by shrinking the liver. However, diets may affect tissue healing and influence bowel anastomosis in an as-yet-undefined manner. Objective: This randomized controlled trial aimed to examine the effect on collagen deposition in wounds in patients on a 4-week VLCD before laparoscopic gastric bypass. Setting: University hospital. Methods: The trial was undertaken in patients undergoing laparoscopic Roux-en-Y gastric bypass, with a control group (n = 10) on normal diet and an intervention group (n = 10) on VLCD (800 kcal) for 4 weeks. The primary outcome measured was expression of collagen I and III in skin wounds, with biopsies taken before and after the diet and 7 days postoperatively as a surrogate of anastomotic healing. Secondary outcome measures included liver volume and fibrosis score, body composition, operating time, blood loss, hospital stay, and complications. Results: Patients in both groups were similar in age, sex, body mass index (53.4 versus 52.8 kg/m 2 ), co-morbidities, liver volume, and body composition. Expression of mature collagen type I was significantly decreased in diet patients compared with controls after 4 weeks of diet and 7 days after surgery. This was significant decrease in liver volume (23% versus 2%, P =.03) but no difference in operating times (129 versus 139 min, P =.16), blood loss, length of stay, or incidence of complications. Conclusions: Preoperative diets shrink liver volume and decrease expression of mature collagen in wounds after surgery. Whether the latter has a detrimental effect on clinical outcomes requires further evaluation.
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U2 - 10.1016/j.soard.2018.10.001
DO - 10.1016/j.soard.2018.10.001
M3 - Article
C2 - 30471928
AN - SCOPUS:85056838273
SN - 1550-7289
VL - 15
SP - 117
EP - 125
JO - Surgery for Obesity and Related Diseases
JF - Surgery for Obesity and Related Diseases
IS - 1
ER -