Whatchu talking about ... Enlarged Fatty Liver?

Hey Tom! Is your surgery going to be open or lap? I was careful to take off some pounds before surgery just for the liver reason. I wanted it healthy and did not want to complicate anything!! So..shrink that liver and YES, we all had them at one time or another. Dianne from FL

You want to get that puppy as small as you can by surgery day, Tom. I lost from 368 to 300 pounds pre-op in order to insure a safer surgery--- and I am told my liver was STILL huge and hard to manipulate!  Do whatcha gotta do!

If you're having laproscopic surgery, they'll likely have you diet like crazy to shrink it so they can maneuver the tools around it.  If it's open, it doesn't matter, really.

Thanks everyone!    I want Lap so I will do anything to get that bugger normal. Sounds like my plan to lose a bunch of weight during my 3 month insurance wait is going to benefit me in more ways than I had planned.  A smaller more healthy liver :) In other news, my gallbladder was in great shape so it's not coming out during the DS.  I'm kinda bummed cause I wanted it out... but will focus on the positive. Tom

1)  This is just me -- I would insist on getting my gall bladder out at the same time. 2)  Dr. Robert Rabkin told me that he doesn't believe that the "liver shrinking diet" does anything much at all, and that bariatric surgeons should expect to find an enlarged liver, and to expect to have to deal with it.  The Pacific Laparoscopy practice has done many many patients with BMIs >60, without a pre-op diet. In my opinion, the pre-op liver shrinking diet isn't worth the stress and torture it puts patients through.  Dr. Rabkin said he would prefer his patients arrive on his operating table hydrated, well-nourished, rested, and as unstressed as possible under the cir****tances.

Thanks Diana.   I'll have to see about the gall bladder issue.  Not sure how to attack that.  I guess I have time and could find some data to support taking it out and ask it be submitted with my WLS approval documents along with a letter from me.  Cost benefits of one surgery vs. two etc. As for the liver, that is very interesting.  I can see Dr. Rabkins position for the 1-2 week preop liquid diet for liver shrinking.    I'm thinking with a normal diet regime between now and surgery I should be able to improve the liver.   Might be intersting to ask for another ultrasound and have my liver measured again right before surgery! Thanks again. Tom

Tom--I am about to agree and disagree with Diana in the same post. First, I too would want my gallbladder out. The odds that you will have problems with it during the rapid weight loss phase are very high. Secondly, I didn't lose weight like I was supposed to before my surgery,my liver was still quite enlarged, and my surgery took 5 and a half hours because of it, rather than the more typical 3 and a half to four hours. So I would do what your surgeon asks you to do in that regard.

I will follow my surgeons instructions!   I am not getting this surgery because I can't lose weight.  It's because I can't keep it off and then gain back more then I lost.  Now that I'm started on the process I am going to lose as much as I can before surgery.  I'm going to increase my protein intake and begin a workout regime to build muscle, stamina and increase my lung capacity.  Since my insurance covers the DS I don't have that fight ahead of me.  I guess I should fight for the gall bladder removal.  I don't want a second surgery. Thanks for the reinforcement. Tom

Make sure you get in DOUBLE your usual fluid volume-- and tell your surgeon you'd prefer to have the gallbladder out if possible. Most surgeons would accomodate this, I think.

I'm gonna second Rabkin's opinion there about the pre-op diet--sorta. True story: I lost 68 pounds in the 4 months before surgery-- and still had a huge and hard to manipulate liver. My surgery was supposed to be at 9:30 am--- and at 4pm they were still trying to get a line in me, because I was so badly dehydrated, and my blood pressure was very low (90/45 when it was previously 120/80). I attribute this to pre-op dieting: I have always gotten much of my fluids through food, never been a great drinker. Additionally: the huge fatty liver meant that I had to keep my gallbladder (which already had sludge and stones in it!). I begged to have it removed-- my doctor said he would do it "if there was time." In part because of my liver, surgery ran very long, and it wasn't possible. I still have gallstones today-- just finished my Ursodiol, and expect a gallbladder attack any time now. Grr. Flip side is that if I hadn't lost the 68 pounds, it would have possibly been larger still, and certainly would have been harder to manipulate. Another piece that's not gonna be too popular: in my experience losing weight before surgery doesn't really speed things up. Sure, you do get closer to your goals faster--but the initial large losses one has while pre-op dieting don't "re-happen" after surgery-- so post op, you will find yourself losing slower than your peers who didn't diet-- and it all turns out to be a wash. I don't believe that significant pre-op weight loss is necessarily all that necessary or beneficial, except in that I am 8 months out and already down 157 pounds...but I would have gotten here either way. The biggest pre-op dieting benefit to me (as an RNYer) is that I had never dieted before (I know, I know!) so my pre-op started getting me in a mindset regarding measuring and accountability that's made the transition a little easier.