Histopathologic Findings in the Resected Stomach Specimen of the Sleeve Gastrectomy

Benjamin L Clapp, MD

Providence Memorial Hospital

Introduction: The vertical sleeve gastrectomy is quickly becoming a preferred bariatric operation. This operation involves resecting most of the stomach. There is a dearth of published data about histopathologic changes in the specimens of morbidly obese patients, especially sleeve patients. The aim of this study is to add more data about the characteristics of the resected gastric specimens to the published literature. There is also a lack of consensus regarding preoperative workup for these patients, and more data regarding the native state of the stomach of morbidly obese patients may be helpful in determining what the work up should include. This may also help determine the usefulness of preoperative endoscopy for evaluating the gastric mucosa with biopsies.

Methods: This was a retrospective review of all patients undergoing laparoscopic sleeve gastrectomies at a single institution. A prospectively maintained database was used to gather our data. Patient characteristics such as age, sex, and initial BMI were examined. The pathology reports of these patients were examined for any histopathological changes or findings. Preoperative endoscopy was not generally performed in asymptomatic patients.

Results: 134 patients over 3 year period had specimens available for review. Eighty-nine of the patients were females. The average starting BMI was 47.5 (range of 35-67.5). Average age at time of operation was 43.5. A minority of patients (47.8%) had findings in the resected specimen. The main histopathologic findings were acute and chronic gastritis in 5 patients, chronic gastritis in 51, follicular lymphoid hyperplasia in 10 patients. There was one lieomyoma, one submucosa lipoma, one esophageal polyp and 2 fundic polyps. Seventy patients had no histopathological changes.

Conclusions: A minority of patients had pathological findings in the resected specimen. The histopathologic changes that did occur were minor. The overwhelming majority of patients would not have had a change in management preoperatively based on these histopathologic findings. These findings may help delineate future guidelines for preoperative evaluation of patients being submitted to sleeve gastrectomy.

Session: Poster Presentation

Program Number: P416