Dr. Kuri

sunseeker37 · March 25, 2007

To all of you out there who have had surgery with Dr. Kuri - do you know why he doesn't require a pre-op diet before surgery if your BMI is under 47? I understand that the purpose of the pre-op diet is to shrink the liver and make the surgery easier and safer. So, I'm not sure why he doesn't require it when most other doctors do. I haven't spoken with Dr. Kuri personally yet so any light you can shed on this for me would be appreciated.

faithmd · March 25, 2007

I cannot speak for Dr. Kuri's reasoning, but there is a lot of research out these pre-op diets and shrinking the liver. The majority of it was done relating to RNY, specifically in the days when most RNY or other WLS was done open versus lap. Though it doesn't really make a huge difference when you are talking about grasping the liver and retracting it whether you are open or not.

Suffice it to say, the research was done to see if shrinking the liver (so that the operative field was easier to visualize and the liver was less likely to receive a traumatic injury from the instruments and manipulation) was beneficial. It was, but the majority of the studies (not a ton of them out there, but the data is solid) showed the longer, the better. Suggesting a four, or six week diet pre-operatively was the "ideal" but who can realistically do that? So I think the surgeons decided that two weeks was acceptable. Still, there are some docs who require three weeks, and occasionally four pre-op if they believe their patient to have a very fatty liver. I'm not sure if this is ALWAYS diagnosed with an abdominal ultrasound, but I know some folks get them. Some surgeons don't subscribe to it, some do. That's why you get differences.

Also, there is the fact that the research was more geared towards a longer and more involved operation that requires more manipulation of the liver (RNY) than what is usually required in AGB (LapBand). I think that's another reason why quite a few of the band surgeons in Mexico (using them as an example) don't require it. They are highly skilled and many of them have exclusively done the band. Their table times are far shorter than a surgeon who has done say, 30 bands. The shorter on the table, the less time in the abdomen, the shorter time the liver needs to be retracted.

Some doctors may also use the pre-op diet as a way to psychologically prepare you for the long time post op that you will be without solid food. There is also some credence to resting the stomach a bit pre-op.

Though I still don't understand why some docs require a bowel prep for the Band!

Here's a link where you can go watch the actual OR, the surgeons doing it explain the whole procedure VERY well. You'll see what I mean by retracting the liver:

http://www.or-live.com/tgh/1593

Hope that helps!