Adam Di Palma1, Sultan Alhabdan1, Azusa Maeda1, Runjan Chetty2, Stefano Serra2, Fayez Quereshy1, Timothy Jackson1, Allan Okrainec1. 1Division of General Surgery, UHN, 2Department of Pathology, UHN
Introduction: Bariatric surgery is currently the most effective approach to weight-loss in morbid obesity and results in improvement of weight-related comorbidities. Laparoscopic sleeve gastrectomy increasingly represents one of the most commonly performed procedures and, in contrast to the Roux-en-Y gastric bypass, produces a surgical specimen for pathologic examination. Few heterogeneous studies have looked at the histopathological findings of these specimens. This study aims to describe the unexpected findings in sleeve gastrectomy in order to better define pre-operative management of these patients.
Methods and Procedures: All cases of laparoscopic sleeve gastrectomy at an academic centre in Toronto, Ontario between September 2010 and May 2017 were reviewed. All specimens underwent macroscopic and microscopic histopathological assessment, while those with findings of neoplasia or suspicious for H. pylori underwent additional immunohistochemical staining. Baseline patient characteristics and surgical outcomes were retrospectively queried from the Ontario Bariatric Network database.
Results: Two-hundred and twenty-two patients and specimens were identified. Patients had a mean age of 48.1 years and pre-operative BMI of 51.2; 80.2% were female and 22.5% had pre-operative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%), PPI-related changes (22.1%), fundic gland polyps (5.4%) and lymphoid aggregates (3.6%). Abnormal findings warranting a change in post-operative management or follow-up were discovered in 19 specimens (8.6%) and included H. pylori infection, intestinal metaplasia, GIST, micro-NET, carcinoma, atrophic gastritis and lymphoma. Of these patients, 8 (4.7%) had not undergone pre-operative endoscopy and had truly unexpected findings requiring change in management post-operatively. No significant association was found between abnormal histopathological findings and age, sex or baseline BMI.
Conclusion: Although a majority of patients undergoing sleeve gastrectomy had normal findings on assessment of their gastric specimen, 8.6% had findings requiring a change in post-operative management or follow-up. This rate drops to 4.7% if patients whose diagnoses were known pre-operatively by endoscopy are excluded. Considering this finding, further research is needed to better define the role of pre-operative endoscopy to potentially reduce the number of unexpected findings following sleeve gastrectomy.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 93272
Program Number: S114
Presentation Session: Bariatric III – Optimizing Care and Pathways
Presentation Type: Podium