P1050 - PREOPERATIVE DIETITIAN-LED CALORIE-RESTRICTED DIET: IMPACT ON LEFT HEPATIC LOBE VOLUME AND LAPAROSCOPIC UPPER GIT SURGERY VISIBILITY

P1050

PREOPERATIVE DIETITIAN-LED CALORIE-RESTRICTED DIET: IMPACT ON LEFT HEPATIC LOBE VOLUME AND LAPAROSCOPIC UPPER GIT SURGERY VISIBILITY

F.-M. Price^1,*, F. N. Schutte², A. Bezuidenhout^2,3,4, J. G. M. Smit^2,3,4, E. Francis², R. Nel⁵, L. van den Berg¹, L. Robb¹

¹Department of Nutrition and Dietetics, , The University of the Free State, Bloemfontein, ²Zuid-Afrikaans Hospital, ³The Univetsity of Pretoria, Pretoria, ⁴Sefako Makgatho Health Sciences University, Ga-Rankuwa, ⁵Department of Biostatistics, The University of the Free State, Bloemfontein, South Africa

Rationale: Hepatomegaly and visceral adiposity complicates laparoscopic surgery of the upper gastrointestinal tract (GIT), which can be averted by introducing a preoperative two-week calorie-restricted regime such as a very low-calorie diet (VLCD) or a low-calorie diet (LCD). The study describes the volumetric changes in left hepatic lobe volume (LHLV) and body composition following a preoperative two-week dietitian-led calorie-restricted diet and the benefits to the surgeon.

Methods: The study included 47 patients scheduled for a hiatus hernia repair with an anti-reflux procedure. Participants were consulted by a dietitian and placed on a two-week 800 or 1 000 kcal daily diet for two weeks before their scheduled surgery. Baseline and post-intervention abdominal ultrasounds and bioelectrical impedance measurements were done to determine changes in LHLV and body composition, respectively.

Results: Statistically significant changes (p < 0.05) in body mass, body mass index (BMI), waist circumference, body fat mass, body fat percentage, abdominal fat and muscle mass were observed. A median LHLV reduction of 33% (IQR 12.8–49.6%, p < 0.05) was noted. The surgeons reported easy access to the esophagogastric (EG) junction in 86.4% of the participants.

Conclusion: A two-week dietitian-led calorie-restricted diet significantly reduces LHLV. A loss of 2.2 kg body fat and 2.5 cm in waist circumference in the two weeks before surgery, will display sufficient decrease in liver volume to allow for improved operative space in the abdominal cavity. This study supports integrating a two-week preoperative VLCD or LCD into potential Enhanced Recover After Surgery (ERAS) protocols for patients with hepatomegaly and increased visceral adiposity undergoing non-bariatric procedures, ensuring that the benefits of such seen in bariatric surgeries extend across other surgical disciplines.

Disclosure of Interest: F.-M. Price Other: Data from this research has been presented as an e-poster at the EASL SLD summit in January 2024, not presented orally. An Article based on this data has also been submitted to the South African Journal of surgery but is not under review yet, F. Schutte: None declared, A. Bezuidenhout: None declared, J. Smit: None declared, E. Francis: None declared, R. Nel: None declared, L. van den Berg: None declared, L. Robb: None declared