418 Shrinking the Liver, Easing the Scalpel: A Systematic Review on Preoperative Liver Shrinkage Diet Compliance Compliance Before Laparoscopic Cholecystectomy

Abstract Background A preoperative liver shrinkage diet, particularly very low-calorie diets, is commonly recommended for obese patients undergoing laparoscopic cholecystectomy to reduce liver volume, facilitate surgical access, and reduce perioperative complications. However, patient compliance varies. This systematic review evaluates the effect of compliance with liver shrinkage diets on operative difficulty, complication rates, and overall perioperative outcomes. Method A systematic search of PubMed Library was conducted for studies published between 2000 and 2025. Eligible studies included randomised controlled trials, cohort studies, and meta-analyses assessing adult patients undergoing laparoscopic cholecystectomy with or without adherence to a liver shrinkage diet. Outcomes analysed included liver volume reduction, operative time, intraoperative difficulty, conversion to open surgery, and post-operative complications. Results Across all studies, adherence to a preoperative liver shrinkage diets resulted in a measurable reduction in liver size and improved intraoperative visibility, operative time, reduced technical difficulty scores and shorter operative duration in liver shrinkage diet-compliant obese patients. Non-compliant patients experienced more intraoperative difficulty, longer operative times, and higher rates of gallbladder perforation and bleeding. A consistent theme was that dietitian involvement improved compliance and outcomes. Conclusions High-quality evidence supports the use of preoperative liver shrinkage diets to improve surgical conditions and reduce perioperative risks in patients undergoing laparoscopic cholecystectomy. Compliance significantly correlates with reduced liver size, operative time, and complication rates. Standardising such diet protocols and embedding dietitian-led services into surgical pathways can enhance patient compliance and improve outcomes. Future research should focus on optimising diet duration, composition, and patient engagement strategies.