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Erschienen in: Obesity Surgery 1/2016

01.01.2016 | Original Contributions

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

verfasst von: Badr AbdullGaffar, Lakshmiah Raman, Ali Khamas, Faisal AlBadri

Erschienen in: Obesity Surgery | Ausgabe 1/2016

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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.
Literatur
1.
Zurück zum Zitat Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):747–59.CrossRef Deitel M, Gagner M, Erickson AL, et al. Third international summit: current status of sleeve gastrectomy. Surg Obes Relat Dis. 2011;7(6):747–59.CrossRef
2.
Zurück zum Zitat Neff KJH, le Roux CW. Bariatric surgery: a best practice article. J Clin Pathol. 2013;66(2):90–8.PubMedCrossRef Neff KJH, le Roux CW. Bariatric surgery: a best practice article. J Clin Pathol. 2013;66(2):90–8.PubMedCrossRef
3.
Zurück zum Zitat Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis. 2013;9(1):21–5.PubMedCrossRef Rawlins L, Rawlins MP, Brown CC, et al. Sleeve gastrectomy: 5-year outcomes of a single institution. Surg Obes Relat Dis. 2013;9(1):21–5.PubMedCrossRef
5.
Zurück zum Zitat Almazeedi S, Al-Sabah S, Al-Mulla A, et al. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg. 2013;23(3):314–9.PubMedCrossRef Almazeedi S, Al-Sabah S, Al-Mulla A, et al. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg. 2013;23(3):314–9.PubMedCrossRef
6.
Zurück zum Zitat Gundogan M, Calli Demirkan N, Tekin K, et al. Gastric histopathological findings and ghrelin expression in morbid obesity. Turk Patoloji Derg. 2013;29(1):19–26.PubMed Gundogan M, Calli Demirkan N, Tekin K, et al. Gastric histopathological findings and ghrelin expression in morbid obesity. Turk Patoloji Derg. 2013;29(1):19–26.PubMed
7.
Zurück zum Zitat Albawardi A, Almarzooqi S, Torab FC. Helicobacter pylori in sleeve gastrectomies: prevalence and rate of complications. Int J Clin Exp Med. 2013;6(2):140–3.PubMedPubMedCentral Albawardi A, Almarzooqi S, Torab FC. Helicobacter pylori in sleeve gastrectomies: prevalence and rate of complications. Int J Clin Exp Med. 2013;6(2):140–3.PubMedPubMedCentral
8.
Zurück zum Zitat Ahmed A. Histopathological spectrum of laparoscopic sleeve gastrectomies in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. KMUJ. 2012;4(2):39–44. Ahmed A. Histopathological spectrum of laparoscopic sleeve gastrectomies in King Fahd Hospital of the University, Al-Khobar, Saudi Arabia. KMUJ. 2012;4(2):39–44.
9.
Zurück zum Zitat Beltran MA, Pujado B, Mendez PE, et al. Gastric gastrointestinal stromal tumor (GIST) incidentally found and resected during laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(3):393–6.PubMedCrossRef Beltran MA, Pujado B, Mendez PE, et al. Gastric gastrointestinal stromal tumor (GIST) incidentally found and resected during laparoscopic sleeve gastrectomy. Obes Surg. 2010;20(3):393–6.PubMedCrossRef
10.
Zurück zum Zitat Sanchez BR, Morton JM, Curet MJ, et al. Incidental finding of gastrointestinal stromal tumors (GISTs) during laparoscopic gastric bypass. Obes Surg. 2005;15(10):1384–8.PubMedCrossRef Sanchez BR, Morton JM, Curet MJ, et al. Incidental finding of gastrointestinal stromal tumors (GISTs) during laparoscopic gastric bypass. Obes Surg. 2005;15(10):1384–8.PubMedCrossRef
11.
Zurück zum Zitat Yuval JB, Khalaileh A, Abu-Gazala M, et al. The true incidence of gastric GIST—a study based on morbidly obese patients undergoing sleeve gastrectomy. Obes Surg. 2014;24:2134–7.PubMedCrossRef Yuval JB, Khalaileh A, Abu-Gazala M, et al. The true incidence of gastric GIST—a study based on morbidly obese patients undergoing sleeve gastrectomy. Obes Surg. 2014;24:2134–7.PubMedCrossRef
12.
Zurück zum Zitat Sohn VY, Arthurs ZM, Martin MJ, et al. Incidental pathologic findings in open resectional gastric bypass specimens with routine cholecystectomy and appendectomy. Surg Obes Relat Dis. 2008;4(12):608–11.PubMedCrossRef Sohn VY, Arthurs ZM, Martin MJ, et al. Incidental pathologic findings in open resectional gastric bypass specimens with routine cholecystectomy and appendectomy. Surg Obes Relat Dis. 2008;4(12):608–11.PubMedCrossRef
13.
Zurück zum Zitat Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg. 2013;23(6):736–9. Peromaa-Haavisto P, Victorzon M. Is routine preoperative upper GI endoscopy needed prior to gastric bypass? Obes Surg. 2013;23(6):736–9.
14.
Zurück zum Zitat Almazeedi S, Al-Sabah S, Alshammari D, et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):412–15. Almazeedi S, Al-Sabah S, Alshammari D, et al. The impact of Helicobacter pylori on the complications of laparoscopic sleeve gastrectomy. Obes Surg. 2014;24(3):412–15.
15.
Zurück zum Zitat Keren D, Matter I, Rainis T, et al. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg. 2009;19(6):751–6. Keren D, Matter I, Rainis T, et al. Sleeve gastrectomy leads to Helicobacter pylori eradication. Obes Surg. 2009;19(6):751–6.
16.
Zurück zum Zitat Jossar GH. Complications of sleeve gastrectomy: bleeding and prevention. Surg Laparosc Endosc Percutan Tech. 2010;20(3):146–7.CrossRef Jossar GH. Complications of sleeve gastrectomy: bleeding and prevention. Surg Laparosc Endosc Percutan Tech. 2010;20(3):146–7.CrossRef
17.
Zurück zum Zitat Braghetto I, Csendes A, Korn O, et al. Gastroesophageal reflux disease after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):148–53.PubMedCrossRef Braghetto I, Csendes A, Korn O, et al. Gastroesophageal reflux disease after sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):148–53.PubMedCrossRef
18.
Zurück zum Zitat Zundel N, Hernandez JD, Galvao Neto M, et al. Strictures after laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):154–8.PubMedCrossRef Zundel N, Hernandez JD, Galvao Neto M, et al. Strictures after laparoscopic sleeve gastrectomy. Surg Laparosc Endosc Percutan Tech. 2010;20(3):154–8.PubMedCrossRef
19.
Zurück zum Zitat Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8.PubMedCrossRef Triantafyllidis G, Lazoura O, Sioka E, et al. Anatomy and complications following laparoscopic sleeve gastrectomy: radiological evaluation and imaging pitfalls. Obes Surg. 2011;21(4):473–8.PubMedCrossRef
20.
Zurück zum Zitat Martin M, Burrell MA, Gomez-Ambrosi J, et al. Short- and long-term changes in gastric morphology and histopathology following sleeve gastrectomy in diet-induced obese rats. Obes Surg. 2012;22(4):634–40.PubMedCrossRef Martin M, Burrell MA, Gomez-Ambrosi J, et al. Short- and long-term changes in gastric morphology and histopathology following sleeve gastrectomy in diet-induced obese rats. Obes Surg. 2012;22(4):634–40.PubMedCrossRef
21.
Zurück zum Zitat van Vliet JL, van Gulik TM, Verbeek PC. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination. Dig Surg. 2013;30(4–6):472–5.PubMedCrossRef van Vliet JL, van Gulik TM, Verbeek PC. Is it necessary to send gallbladder specimens for routine histopathological examination after cholecystectomy? The use of macroscopic examination. Dig Surg. 2013;30(4–6):472–5.PubMedCrossRef
22.
Zurück zum Zitat Deng YL, Xiong XZ, Zhou Y, et al. Selective histology of cholecystectomy specimens—is it justified? J Surg Res. 2015;193(1):196–201.PubMedCrossRef Deng YL, Xiong XZ, Zhou Y, et al. Selective histology of cholecystectomy specimens—is it justified? J Surg Res. 2015;193(1):196–201.PubMedCrossRef
23.
Zurück zum Zitat Alvi A, Vartanian AJ. Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngo Head Neck Surg. 1998;119(4):361–3.CrossRef Alvi A, Vartanian AJ. Microscopic examination of routine tonsillectomy specimens: is it necessary? Otolaryngo Head Neck Surg. 1998;119(4):361–3.CrossRef
24.
Zurück zum Zitat Williams MD, Brown HM. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol. 2003;34(10):1053–7.PubMedCrossRef Williams MD, Brown HM. The adequacy of gross pathological examination of routine tonsils and adenoids in patients 21 years old and younger. Hum Pathol. 2003;34(10):1053–7.PubMedCrossRef
25.
Zurück zum Zitat Lohsiriwat VL, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg. 2009;33(10):2189–93.PubMedCrossRef Lohsiriwat VL, Vongjirad A, Lohsiriwat D. Value of routine histopathologic examination of three common surgical specimens: appendix, gallbladder, and hemorrhoid. World J Surg. 2009;33(10):2189–93.PubMedCrossRef
26.
Zurück zum Zitat Ramraje SN, Pawar VI. Routine histopathologic examination of two common surgical specimens-appendix and gallbladder: is it a waste of expertise and hospital resources? Indian J Surg. 2014;76(2):127–30.PubMedPubMedCentralCrossRef Ramraje SN, Pawar VI. Routine histopathologic examination of two common surgical specimens-appendix and gallbladder: is it a waste of expertise and hospital resources? Indian J Surg. 2014;76(2):127–30.PubMedPubMedCentralCrossRef
27.
Zurück zum Zitat Matthyssens LE, Ziol M, Barrat C, et al. Routine surgical pathology in general surgery. Br J Surg. 2006;93(3):362–8.PubMedCrossRef Matthyssens LE, Ziol M, Barrat C, et al. Routine surgical pathology in general surgery. Br J Surg. 2006;93(3):362–8.PubMedCrossRef
Metadaten
Titel
Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?
verfasst von
Badr AbdullGaffar
Lakshmiah Raman
Ali Khamas
Faisal AlBadri
Publikationsdatum
01.01.2016
Verlag
Springer US
Erschienen in
Obesity Surgery / Ausgabe 1/2016
Print ISSN: 0960-8923
Elektronische ISSN: 1708-0428
DOI
https://doi.org/10.1007/s11695-015-1726-3

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