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.

Laparoscopic Sleeve Gastrectomy has A Positive Impact on Subclinical Hypothyroidism Among Obese Patients: A Prospective Study.

BACKGROUND: The effect of bariatric surgery on postoperative thyroid function remains incompletely understood. In this study, we aimed to evaluate the changes in thyroid functions after gastric sleeve operation for morbidly obese Egyptian patients. METHODS: This was a prospective study that recruited 128 patients who underwent sleeve gastrectomy through the period from December 2016 to April 2020. We measured thyroid-stimulating hormone (TSH), free thyroxin (FT4), and free triiodothyronine. Subclinical hypothyroidism was defined by a TSH level > 4.5 mIU/L but a normal FT4 level. All patients were followed for 12 months after the procedure. RESULTS: Preoperatively, 30 (23.4%) patients had subclinical hypothyroidism. The prevalence of subclinical hypothyroidism decreased significantly to reach 7.8% at the end of follow-up (p < 0.001). None of the patients developed de novo hypothyroidism at the end of follow-up. Patients with subclinical hypothyroidism were more likely to be females (p = 0.037) and had significantly higher waist circumference (p < 0.001), DBP (p = 0.02), serum cholesterol (p < 0.001), and serum triglyceride (p < 0.001). However, patients with subclinical hypothyroidism at the end of follow-up had significantly higher BMI at the end of the sixth month (p = 0.048). Similarly, patients with subclinical hypothyroidism at the end of follow-up had significantly higher serum cholesterol (p = 0.002), LDL, (p = 0.038), and serum triglyceride (p < 0.001) at the end of the sixth months of follow-up. A similar trend was noted at the end of the 12th month. The preoperative value of serum TSH correlated significantly with serum cholesterol and triglyceride levels. CONCLUSION: The positive effect of the LSG procedure on the hypothyroid bariatric population, including enhanced thyroid function, was demonstrated.