D.NG1, B.C.TAN1, K.T.LIM1, SURESH.B.BABU1, C.H.TAN2, A.K.S.CHENG1
Khoo Teck Puat Hospital1, Surgicare Bariatric and General Surgery Clinic2
Background: Adequate access to the gastro-esophageal junction(GEJ) is essential in bariatric surgery. Morbidly obese patients have large livers & limited access to these areas. Very Low Calorie Diet(VLCD)is commonly used to reduce the liver size pre-operation. VLCD is costly & initial hunger may lead to poor compliance with suboptimal pre-operative preparation.
Omega-3 supplementation is cheap & has been found to reduce hepatic steatosis by reducing lipogenic gene expression & in theory can reduce liver size.
Objectives: This is a safety & efficacy study to investigate the effect on liver size from 4 weeks of pre-operative Omega-3 supplement.
Patients with BMI<45, without excessive central obesity, who were planned for Bariatric Surgery were recruited. A dietician provided standard pre- bariatric surgery dietary counseling. The patient was given 2g/day of Omega-3 for 4 weeks. Liver size measurement using ultrasound scan & blood tests were performed pre & post omega-3. The operating surgeon subjectively scored the ease of access to the GEJ using Likert scale of 1 to 5 (easiest to most difficult).
13 patients completed the study & 7 awaiting surgery. Mean age 43 years. Mean pre-intervention weight BMI was 101.6kg,37kg/m2.
Pre- & post-intervention liver size was 1837±424cm3 & 1673±373cm3 respectively. The mean liver size reduction was-165±106cm3(p<0.0001).
All patients experienced a reduction in liver size(min-12.5cm3,max -374cm3).Six patients lost weight -1.47kg(average) but 7 gained weight +1.58kg.
The average ease of access to the GEJ was 1.9/5 on Likert scale. 8 patients had score 2/5,3 had score 1/5 &2 had score 3/5. The operative time & length of stay was 108min & 2.5days respectively.
There was 1 port site hematoma, treated conservatively. Compliance was 92% with no adverse effects. There was 1 drop out due to financial reasons.
Four weeks of Omega-3 supplementation is safe & may be a cheaper alternative to VLCD for liver size reduction pre-bariatric surgery.