Does anyone know why the liver has to shrink prior to surgery? What complications can you have as a result of the liver not shrinking?

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The theory is that the liver can be shrunk by eating a low calorie, low fat no sugar diet. Several studies have been done to prove this theory. Though some say that any weight loss will help it to shrink.

Many surgeons prefer their patients to do this diet to shrink pre-op because it is easier to retract a smaller liver out of the operative field. The lap band is placed laparascopically through several holes in your belly and then a gas is pumped into it to blow it up so they can see where they are operating. The liver lies over the area that needs to be accessed to place the band. It must be grabbed with an instrument and moved out of the way. If it is big and boggy and fatty, then that does make it a bit harder to move (retract) out of the way. If your liver tears, that's a bad thing. So a smaller liver helps to avoid these problems. I have heard tell that there have been occasions (though I don't know of any personally) where people have either had to be opened up to place the band (though that's really tough as it was not designed for placement via an open incision), or some folks have been woken up and told their liver is too large to safely do the surgery and then they were placed on a longer diet. Again, I don't have any personal experience with either of these scenarios, but that's what we're told can happen.

Some docs do not require a pre-op diet. Usually you will find those docs have been placing the band for a VERY long time and are very skilled at what they are doing, others may just not buy into the liver shrinking theory. Though it was presented at the ASBS (American Society of Bariatric Surgeons) meeting last month again.