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Preoperative 4-week low-calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Surgical Sciences, Upper Abdominal Surgery.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Radiology, Oncology and Radiation Science, Radiology.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Public Health and Caring Sciences, Geriatrics.
Uppsala University, Disciplinary Domain of Medicine and Pharmacy, Faculty of Medicine, Department of Medical Sciences. (Endokrinologi, diabetes och metabolism)
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2011 (English)In: Obesity Surgery, ISSN 0960-8923, E-ISSN 1708-0428, Vol. 21, no 3, 345-350 p.Article in journal (Refereed) Published
Abstract [en]

BACKGROUND: The aim of this study was to explore changes in liver volume and intrahepatic fat in morbidly obese patients during 4 weeks of low-calorie diet (LCD) before surgery and to investigate if these changes would facilitate the following laparoscopic gastric bypass.

METHODS: Fifteen female patients (121.3 kg, BMI 42.9) were treated preoperatively in an open study with LCD (800-1,100 kcal/day) during 4 weeks. Liver volume and fat content were assessed by magnetic resonance imaging and spectroscopy before and after the LCD treatment.

RESULTS: Liver appearance and the complexity of the surgery were scored at the operation. Eighteen control patients (114.4 kg, BMI 40.8), without LCD were scored similarly. Average weight loss in the LCD group was 7.5 kg, giving a mean weight of 113.9 kg at surgery. Liver volume decreased by 12% (p < 0.001) and intrahepatic fat by 40% (p < 0.001). According to the preoperative scoring, the size of the left liver lobe, sharpness of the liver edge, and exposure of the hiatal region were improved in the LCD group compared to the controls (all p < 0.05).

CONCLUSIONS: The overall complexity of the surgery was perceived lower in the LCD group (p < 0.05), due to improved exposure and reduced psychological stress (both p < 0.05). Four weeks of preoperative LCD resulted in a significant decrease in liver volume and intrahepatic fat content, and facilitated the subsequent laparoscopic gastric bypass as scored by the surgeon

Place, publisher, year, edition, pages
2011. Vol. 21, no 3, 345-350 p.
Keyword [en]
Gastric bypass, Laparoscopy, Low-calorie diet, Magnetic resonance, Morbid obesity
National Category
Medical and Health Sciences
Research subject
Surgery
Identifiers
URN: urn:nbn:se:uu:diva-142256DOI: 10.1007/s11695-010-0337-2ISI: 000287523200013PubMedID: 21181291OAI: oai:DiVA.org:uu-142256DiVA: diva2:387192
Available from: 2011-01-13 Created: 2011-01-13 Last updated: 2017-12-11Bibliographically approved
In thesis
1. Gastric Bypass: Facilitating the Procedure and Long-term Results
Open this publication in new window or tab >>Gastric Bypass: Facilitating the Procedure and Long-term Results
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Gastric bypass achieves weight loss in the morbidly obese. Preoperative weight loss is used to reduce the enlarged fatty liver that otherwise reduces visibility during surgery. The purpose of gastric bypass is to provide patients with long-term weight loss. The aim of this thesis was to investigate the result of preoperative low calorie diet on liver volume and to evaluate the long-term result of gastric bypass.

Paper I showed that four weeks of low calorie diet reduces intrahepatic fat by 40% and facilitates surgery mainly through improved visualisation. Paper II demonstrated that all of the reduction of liver volume occurs during the first two weeks of treatment with low calorie diet.  In paper I liver volume was reduced by 12% and in paper II by 18%. Paper III focused on long-term results and showed that gastric bypass achieves a mean 63% excess body mass index loss in obese patients after 11 years. However, of these 40% undergo abdominoplasty and 2% require additional bariatric surgery. Only 24% adhere to the lifelong recommendation on multivitamins and 72% to Vitamin B12 recommendations. Paper IV evaluated gastric bypass as a revisional procedure after earlier restrictive surgery had failed. Similar weight results as after primary gastric bypass are attained. No patient taking vitamin B12 supplementation was deficient at follow-up, regardless of whether the vitamin was taken as a pill or as intramuscular injections.

Place, publisher, year, edition, pages
Uppsala: Acta Universitatis Upsaliensis, 2014. 66 p.
Series
Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine, ISSN 1651-6206 ; 967
Keyword
Morbid obesity, Gastric bypass, Laparoscopy, Low-calorie diet, Magnetic resonance imaging, Magnetic resonance spectroscopy
National Category
Surgery Gastroenterology and Hepatology Radiology, Nuclear Medicine and Medical Imaging
Research subject
Surgery
Identifiers
urn:nbn:se:uu:diva-213785 (URN)978-91-554-8851-2 (ISBN)
Public defence
2014-02-28, Grönwallsalen, Akademiska sjukhuset, Uppsala, 09:15 (Swedish)
Opponent
Supervisors
Available from: 2014-02-06 Created: 2014-01-03 Last updated: 2014-02-10

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Edholm, DavidKullberg, JoelKarlsson, Anders F.Hedberg, JakobAhlström, HåkanSundbom, Magnus

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