Lesson learned from bariatric surgery: Preventing intra- and perioperative complications in patients with obesity undergoing laparoscopic adrenalectomy: Role of ketogenic preoperative diet: A propensity score matching analysis of a single-center experience

Background: Laparoscopic adrenalectomy is the preferred surgical approach for adrenal resection. The simultaneous presence of obesity and subsequent liver steatosis may complicate the procedure, increasing the risk of intra- and perioperative complications. This study explores the effectiveness of a preoperative very low-calorie ketogenic diet in improving surgical outcomes in patients with obesity undergoing laparoscopic adrenalectomy. Methods: A retrospective analysis was conducted on 70 patients from January 2021 to July 2024 at the Bariatric and Endocrine-Metabolic Surgery Unit, University of Naples “Federico II.” Among these, 54 patients with a body mass index ≥30 kg/m2 were divided into 2 groups: group A, which underwent a 4-week very low-calorie ketogenic diet, and group B, which did not receive any dietary intervention. Propensity score matching was used to balance the groups for confounding factors. Furthermore, a subanalysis between groups was performed according to right and left laparoscopic adrenalectomy. Results: Group A had a significantly reduced operative time (94.59 ± 54.11 minutes) compared with group B (129.22 ± 51.06 minutes, P = .01). Additionally, group A exhibited fewer perioperative complications (P = .01). The very low-calorie ketogenic diet was also associated with a significant reduction in body mass index from 31.74 ± 1.31 kg/m2 to 29.05 ± 0.99 kg/m2 (P = .001) before surgery. Conclusions: Our analysis suggests preoperative very low-calorie ketogenic diet can significantly improve surgical outcomes in patients with obesity scheduled to adrenal glands surgery. The study supports the integration of dietary interventions into the preoperative management of patients with obesity undergoing laparoscopic adrenalectomy. Future research with larger sample sizes and randomized controlled trials is recommended to validate these findings and optimize preoperative care protocols.