The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy

Öz

Objectives: The prevalence of obesity has been increas­ing in recent decades in developed countries. Slight and moderate obesity is associated with various co-morbid­ities. The most severe forms of obesity are consistently associated with the development of various health prob­lems. The aim of this study was to investigate and analyze the most important histopathological lesions obtained by sleeve gastrectomy postoperatively. Materials and methods: We investigated 87 surgical interventions, performed between October of 2007 and June of 2008 for bariatric therapy procedures, using sleeve gastrectomy. All the specimens (gastric, liver and adipose tissue) were processed in the Pathology Depart­ment. The specimens were fixed in buffered formalin, and then stained with hematoxilin eosin. Results: The female to male ratio was 2/1. Young patients aged between 31-40 years were most frequently (39.1%) affected. The frequent histopathological lesions were pari­etal cells hyperplasia (63.2%), ulcerations (34.5%), lymph nodes hyperplasia in lamina propria (33.3%), active gas­tritis (23.0%) and other lesions (10.3%). The parietal cells hyperplasia found in fornix and corpus mucosa was the most frequent lesion encountered in obese patients. All three cases showed an important steatosis of the hepato­cytes by liver biopsy. Conclusions: Our results suggest that the histopathol­ogy analysis of the gastric mucosa of the fornix and other tissues (as the liver) is relevant for the comorbidities of the obese patients. The evaluation of the histopathological gastric and liver aspects could improve the understanding of the local mechanism and the outcome of the patients.

Anahtar Kelimeler

• Morbid obesity, sleeve gastrectomy, histopa­thology, lesions

Tüp gastrektomi yapılan obez hastalardaki ana histopatolojik lezyonlar

Öz

Amaç: Obezite prevalansı son on yıllarda gelişmiş ülke­lerde artmaktadır. Hafif ve orta obezite çeşitli morbidite ile birliktedir. Obezitenin ağır formları çeşitli sağlık problem­leri ile birliktedir. Bu çalışmanın amacı tüp gastrektomi ile elde edilen dokudaki histopatolojik lezyonları araştırmak ve analiz etmektir. Yöntemler: Ekim 2007 ile haziran 2008 arasında tüp gastrektomi uygulanan 87 cerrahi girişimden elde edilen dokular incelendi. Tüm doku örnekleri (mide, karaciğer, yağ dokusu) Patoloji bölümünde incelendi. Doku örnekleri formalinde fiske edilerek hematoksieln eozinle boyandı. Bulgular: Kadın/erkek oranı 2/1 idi. Yaşları 31-40 ara­sında olan geç hastalar en sık etkilenmişti (%39.1). Sık rastlanan histopatolojik lezyonlar pariyetal hücre hiperpla­zisi (%63.2), ülserasyonlar (%34.5), lamina propriada lenf nodu hiperplazisi (%33.3), aktif gastrit (%23.0) ve diğer lezyonlar (%10.3) oranlarında saptandı. Mide forniks ve korpus mukozasındaki pariyetal hücre hiperplazisi obez hastalarda en sık rastlanan lezyon idi. Karaciğer biyopsi yapılan üç hastada hepatositlerde steatozis saptandı. Sonuç: Bizim sonuçlarımız obez hastalarda mide forniks mukoza ve karaciğer gibi diğer dokuların histopatolojik analizi ko-morbiditelerle birlikte bulundu. Obez hastalar­daki gastrik ve karaciğer lezyonların histopatolojik ince­lenmesi lokal mekanizmaları ve hastaların sonuçlarını daha iyi anlamaya yardımcı olabilir.

Anahtar Kelimeler

• Ağır obezite, tüp gastrektomi, histo­patoloji, lezyonlar

Kaynakça

1. NICE issues guidance on surgery for morbid obesity. (2002). National Clinical Institute for Clinical Excellence (2002/041); http/www.who.int
2. Hunter DJ. Gene-environment interactions in human diseas- es. Nat Rev Genet 2005;6: 287–98.
3. Kaput J, Ordovas JM, Ferguson L, et al. The case for strategic international alliances to harness nutritional genomics for public and personal health. Br J Nutr 2005;94:623–632.
4. Rankinen T, Zuberi A, Chagnon YC, et al. The human obe- sity gene map: The 2005 update. Obesity (Silver Spring) 2006;14: 529–644.
5. Bell CG, Walley AJ, Froguel P. The genetics of human obe- sity. Nat Rev Genet 2005;6: 221–34.
6. Mutch David M., Karine Cle´ment Unraveling the Genetics of Human Obesity PLoS Genetics | www.plosgenetics.org 2006;2:e188
7. Mutch DM, Wahli W, Williamson G. Nutrigenomics and nutrigenetics: The emerging faces of nutrition. FASEB J 2005;19: 1602-16.
8. Isomaa B, Almgren P, Tuomi T, et al. Cardiovascular morbid- ity and mortality associated with the metabolic syndrome. Diabetes Care 2001;24:683-9.

9. DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med 2007;24;356:2176-83.
10. de Zwaan M, Mitchell JE, Howell LM et al. Characteristics of morbidly obese patients before gastric bypass surgery. Compr Psychiatry 2003;44:428-34.
11. NICE clinical guidance (2006): Obesity: the prevention, identification, assessment and management of overweight and obesity in adults and children (www.nice2006.com )
12. Buchwald H, Avidor Y, Braunwald E, et al. Bariatric sur- gery: a systematic review and meta-analysis. JAMA 2004;292:1724-37. [abstract]
13. Cottam D, Qureshi FG, Mattar SG, et al. Laparoscopic sleeve gastrectomy as an intitial weight loss procedure for high-risk patients with morbid obesity. Surg Endosc 2006;20:859-63.
14. Gagner M, Matteotti M. Laparoscopic biliopancre- atic diversion with duodenal switch. Surg Clin N Am 2005;85:141–9.
15. Ren CJ, Patterson E, Gagner M. Early results of laparoscop- ic biliopancreatic diversion with duodenal switch: a case series of 40 consecutive patients. Obes Surg 2000;10:514- 23.
16. Silecchia G, Boru C, Pecchia A, et al. Effectiveness of lap- aroscopic sleeve gastrectomy (First stage of biliopancreatic diversion with duodenal switch) on comobidities in super- obese high-risk patients. Obes Surg 2006;16:1138-44.
17. Han SM, Kim WW, Oh JH. Results of laparoscopic sleeve gastrectomy (LSG) at 1 year in morbidly obese Korean pa- tients. Obes Surg 2005;15:1469-75.
18. Mognol P, Choisdow D, Marmuse JP. Laparoscopic sleeve gastrectomy as an initial bariatric operation for high-risk patients: Initial results in 10 patients. Obes Surg 2005;15:1030-3.
19. Bray GA. The missing link: lose weight, live longer. N Engl J Med 2007; 357:818-20.
20. Clinical guidelines on the identification, evaluation, and treatment of overweight and obesity in adults-the evidence report. National Institutes of Health. Obes Res 1998;6:51S- 209S.
21. Santry HP, Gillen DL, Lauderdale DS. Trends in bariatric surgical procedures. JAMA 2005;294:1909-17.
22. Baltasar A, Serra C, Perez N, Bou M, Bengochea M, Ferri L. Laparoscopic sleeve gastrectomy: A multi-purpose bar- iatric operation. Obes Surg 2005;15:1124-8.
23. Himpens J, Dapri G, Cadiere GB. A prospective random- ized study between laparoscopic gastric banding and lap- aroscopic isolated sleeve gastrectomy: Results after 1 and 3 years. Obes Surg 2006;16:1450-6
24. Milone L, Strong V, Gagner M. Laparoscopic sleeve gas- trectomy is superior to endoscopic intragastric balloon as a first stage procedure for super-obese patients (BMI>50). Obes Surg. 2005;15:612-7.
25. Regan JP, Inabnet WB, Gagner M, Pomp A. Early expe- rience with two-stage laparoscopic Roux-en-Y gastric by- pass as an alternative in the super-super obese patient. Obes Surg 2003;13:861-4.
26. Kotidis EV, Koliakos GG, Baltzopoulos VG, et al. Serum ghrelin, leptin, and adiponectin levels before and after weight loss: Comparison of three methods of treatment- a prospective study. Obes Surg. 2006;16:1425-32.
27. Almogy G, Crookes PF, Anthone GJ. Longitudinal gastrec- tomy as a treatment for the high-risk super-obese patient. Obes Surg 2004;14:492-7.
28. Adams TD, Gress RE, Smith SC, et al. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753- 761. [abstract]
29. Bernante P, Foletto M, Busetto L, et al. Feasibility of laparo- scopic sleeve gastrectomy as a revision procedure for prior laparoscopic gastric banding. Obes Surg 2006;16:1327-30.
30. Angulo P. Nonalcoholic fatty liver disease. New Engl J Med 2002; 346: 1221-31.
31. Ludwig J, Viggiona TR, McGill DB et al. Nonalcoholic ste- atohepatitis: Mayo Clinic experiences with a hither-to un- named disease. Mayo Clin Proc 1980; 55: 434-8.
32. Lee RJ. (ed): Fatty changes and steatohepatitis, in Diag- nostic liver pathology. St Louis, Mosby-Yearbook, 1994, 167-194.
33. Dixon JB, Bhathal PS, O’Brien PE. Nonalcoholic fatty liver disease: Predictors of nonalcoholic steatohepatitis and liver fibrosis in severely obese. Gastroenterol 2001;121:91-100.