Effects of preoperative carbohydrate loading on postoperative outcomes in patients undergoing laparoscopic cholecystectomy: a systematic review and meta-analysis

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Background: Cholecystectomy is one of the most common procedures performed across the world. With efforts to maximize good postoperative status, one such technique involves preoperative carbohydrate loading. Methods: A thorough literature search was performed across three databases to identify articles published up to August 2024. The screening was conducted to select all primary studies evaluating the role of preoperative carbohydrate loading in patients undergoing laparoscopic cholecystectomy. Statistical analysis was conducted via RevMan using a random-effects model. Results: Thirteen records were included for quantitative synthesis, encompassing 827 participants (415 in the carbohydrate arm and 412 in the fasting arm). Carbohydrate loading was associated with significantly higher insulin levels compared to the control group (standard mean deviation [SMD]: −0.60; 95% confidence interval [CI]: −0.87, −0.34; P < 0.00001). However, other parameters like blood glucose (SMD: −0.19; 95%CI: −0.52, 0.14; P = 0.26) and homeostatic model assessment for insulin resistance (HOMA-IR) levels (SMD: −0.26; 95%CI: −0.82, 0.31; P = 0.37) had non-significant differences between both groups. On the contrary, post-operative pain levels were found to be lower among the carbohydrate group (SMD: −0.76; 95% CI: −1.35, −0.16; P = 0.01). Other outcomes like quality of recovery, use of antiemetics, or blood loss during operation had no significant differences between both groups. Conclusion: Our analysis suggests that preoperative carbohydrate loading is linked with reduced postoperative pain, incidence of nausea, and superior insulin parameters. Further research is needed to strengthen these findings.

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