A fatty liver sits directly over the stomach and blocks the surgeon's view. Two strict low-carbohydrate weeks shrink it enough to keep the operation keyhole.
The left lobe of the liver lies directly over the top of the stomach, exactly where a sleeve or a bypass is constructed. In severe obesity that lobe is enlarged, loaded with fat and unusually fragile, so the retractor holding it out of the way can tear it. A torn liver bleeds into the operative field, and a field the surgeon cannot see clearly is a field where staple lines go wrong. In the worst case the operation is converted to open surgery or abandoned.
Two weeks, roughly 800 to 1,000 calories a day, with carbohydrate held under about fifty grams. In practice that means three protein shakes and one small meal of lean protein with green vegetables, two litres of water, and no bread, rice, pasta, potato, fruit juice or alcohol at all. The point is glycogen depletion: glycogen binds water, and emptying those stores drains the liver of both. Two disciplined weeks typically reduce liver volume by fifteen to twenty percent, which is enough.
Expect a dull headache, flat energy and a short temper while carbohydrate is withdrawn; it peaks around day two and fades by day four. Salt in the form of clear broth, generous water and keeping your usual coffee all soften the landing. Nobody enjoys this fortnight, but it doubles as a rehearsal: the portion sizes, the protein-first order and the slow eating are precisely what the year after surgery will require of you anyway.
The surgeon finds out within the first minute, because the liver is the first thing the camera sees. We have postponed operations on the table for exactly this reason, and a postponement abroad means changed flights and an extra week of hotel. This is not a test of obedience, it is mechanical. We ask for a photograph of the scale the day before you fly, and if the fortnight has not happened, tell us before boarding rather than afterwards.
Yes, provided each serving delivers at least twenty grams of protein and under ten grams of carbohydrate. The brand does not matter; the macronutrients do. Send us a photograph of the label if you are unsure.
Ten strict days beat fourteen sloppy ones. Tell us the real start date so the surgical team knows what to expect rather than discovering it in theatre.