Preoperative low energy diet diminishes liver size

Background: A limited view of the gastro-esophageal area in obese patients is often aggravated by an enlarged liver due to fatty infiltration. Preoperative decrease in liver size would help surgeons, particularly those not used to working with morbidly obese patients. Methods: 50 morbidly obese patients booked for laparoscopic gastric banding undertook a 2-week, preoperative low energy liquid diet. Ultrasound measurements of the left lobe of the liver and body analysis were undertaken at the start of the diet, and again at the conclusion of the diet (preoperatively). Changes in liver size were compared to body analysis changes. Results: There was a highly significant decrease in liver size in the 2 weeks, which correlated with BMI and weight loss. There was no correlation with fat loss. No large left lobe of the liver was encountered at surgery nor caused any problem in any patients with successful preoperative weight loss. Conclusions: Preoperative restriction of dietary energy will reduce liver size, and is accurately predicted by associated weight loss.