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Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary?

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Abstract

Background

The value of the routine histopathologic examination of resected gastric remnants following laparoscopic sleeve gastrectomy (LSG) remains to be controversial. This study aimed to determine whether the routine histopathologic examination of gastric specimens is necessary for all patients undergoing LSG if upper gastrointestinal endoscopy (UGIE) plus multiple biopsies are performed routinely during the preoperative work-up.

Materials and Methods

Clinicopathologic data of 474 patients who underwent LSG were analysed. Types of histopathologic findings in LSG specimens and the prevalence of these and Helicobacter pylori (HP) infection were estimated. Comparisons were conducted to assess the association of risk factors with the most frequent abnormal and premalignant histopathologic findings.

Results

Chronic gastritis was the most common gastric pathology (63.5%) and premalignant lesions were present in 7.8% of the specimens. The prevalence of HP infection was 36.9%. A statistically significant association was observed between HP infection and chronic gastritis (P = .000), and premalignant lesions (P = .000). Similarly, a statistically significant association was noted between age and premalignant gastric lesions (P = .000).

Conclusion

Histopathologic examination of LSG specimens may not be routinely needed and can be performed on selected patients. While we recommend routine preoperative UGIE in all LSG-treated patients, we suggest that histopathologic assessment of the LSG specimens should be mandatory when UGIE biopsies demonstrate HP infection and/or premalignant lesions, in all patients older than 42 years, and in cases of intraoperative detection of incidental tumours or suspicious lesions.

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Author notes

  1. Iman Komaei and Giuseppe Currò contributed equally to this work.

Authors and Affiliations

  1. Department of Human Pathology of Adult and Evolutive Age, General Surgery Unit, University Hospital of Messina, Via Consolare Valeria 1, 98125, Messina, ME, Italy

    Iman Komaei, Giuseppe Currò, Federica Mento, Gabriele Cassaro, Claudio Lazzara, Adalberto Barbera & Giuseppe Navarra

  2. Department of Health Sciences, General Surgery Unit, Magna Graecia University of Catanzaro, Catanzaro, Italy

    Giuseppe Currò & Michele Ammendola

  3. Department of Economics, University of Messina, Messina, Italy

    Angela Alibrandi

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  1. Iman Komaei
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  2. Giuseppe Currò
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  4. Gabriele Cassaro
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  9. Giuseppe Navarra
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Corresponding author

Correspondence to Giuseppe Currò.

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

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Komaei, I., Currò, G., Mento, F. et al. Gastric Histopathologic Findings in South Italian Morbidly Obese Patients Undergoing Laparoscopic Sleeve Gastrectomy: Is Histopathologic Examination of All Resected Gastric Specimens Necessary?. OBES SURG 30, 1339–1346 (2020). https://doi.org/10.1007/s11695-019-04272-x

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