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Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?

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Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure to reduce weight in morbidly obese patients, with an overall low rate of complications and thus gaining a worldwide popularity. It provides an opportunity to study the pathology of the stomach in obese patients. Most studies, however, focused on clinical aspects, surgical techniques, and postoperative complications. Few authors studied the histopathologic findings. Whether routine histopathologic examination is warranted in patients with grossly unremarkable LSG specimens and nonsignificant clinical history was not previously studied.

Methods

We conducted a prospective study over 8 years to compare the prevalence, the morphologic spectrum and importance of histopathologic findings, and the frequency of incidental neoplasms in LSG specimens with other studies. We also proposed a protocol for the gross handling and sectioning of LSG specimens.

Results

We found 546 LSG specimens. Five patients developed iatrogenic postoperative complications, two of which pursued a medicolegal case. There was no association between the histopathologic findings and the complications. Less than 1 % of incidental benign lesions were found. No malignancies were identified. All of the patients without postoperative complications had uneventful outcome after 5 months to 6 years follow-up.

Conclusions

Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient’s safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.

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Conflict of Interest

The authors declare that they have no competing interests.

Statement of Informed Consent

Informed consents were obtained from all individual participants included in the study.

Statement of Human and Animal Rights

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Funding

There are no sources or grants of financial support from any institution to be disclosed and no conflict of interests to be disclaimed or financial disclosure to be declared.

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Authors and Affiliations

  1. Pathology Section, Rashid Hospital, Oud Metha Road, Dubai, United Arab Emirates

    Badr AbdullGaffar

  2. Histopathology Unit, Dubai Hospital, Dubai, United Arab Emirates

    Lakshmiah Raman

  3. Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates

    Ali Khamas & Faisal AlBadri

Authors
  1. Badr AbdullGaffar
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  2. Lakshmiah Raman
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  3. Ali Khamas
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  4. Faisal AlBadri
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Correspondence to Badr AbdullGaffar.

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AbdullGaffar, B., Raman, L., Khamas, A. et al. Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?. OBES SURG 26, 105–110 (2016). https://doi.org/10.1007/s11695-015-1726-3

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  • DOI: https://doi.org/10.1007/s11695-015-1726-3

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