HISTOPATHOLOGICAL FINDINGS AND CLINICAL OUTCOMES OF PATIENTS AFTER LAPAROSCOPIC SLEEVE GASTRECTOMY

Abstract

Background: Laparoscopic sleeve gastrectomy (LSG) has become an increasingly common method for surgical treatment of morbid obesity in recent years. This study aimed to evaluate the histopathological findings of gastrectomy specimens obtained in LSG and the clinical outcomes of patients. Material and methods: Between June 2018 and December 2019, the resected gastric samples of 170 patients with LSG underwent histopathological examination. Results: Histopathologic examination is routinely performed on gastric specimen that is resected during the sleeve gastrectomy for histopathologic examinations of the severity of inflammation, atrophy, intestinal metaplasia, and H. pylori infection. We found that the most common histopathological findings were chronic gastritis (58.2%), normal gastric mucosa (17.6%), and chronic active gastritis (12.4%). Patients with normal gastric histopathology after LSG lost more weight at the end of the 1st, 3rd, 6th, and 12th months than those with abnormal histopathological findings (chronic gastritis, chronic active gastritis, and edema congestion). Conclusions: Histopathologic examinations are extremely necessary in diagnosing lesions that may have been missed in endoscopies before sleeve gastrectomy. Many factors, such as age, sex, histopathology of the removed stomach, and H. pylori positivity, should be considered in predicting postoperative weight loss success.

Keywords

• obesity,sleeve gastrectomy,bariatirc surgery

Project Number

yok

References

1. REFERENCES 1. WHO | Overweight and obesity [Internet]. WHO. [cited 2019 Nov 22]. Available from: http://www.who.int/gho/ncd/risk_factors/overweight/en/.
2. 2. Solomon CG, Dluhy RG. Bariatric surgery--quick fix or long-term solution? N Engl J Med. 2004;351(26):2751–3.
3. 3. Sjöström L, Lindroos AK, Peltonen M, et al. Lifestyle, diabetes, and cardiovascular risk factors 10 years after bariatric surgery. N Engl J Med. 2004;351(26):2683–93.
4. 4. Buchwald H, Oien DM. Metabolic/bariatric surgery Worldwide 2008. Obes Surg. 2009;19(12):1605–11.
5. 5. Onzi TR, d’Acampora AJ, de Araújo FM, et al. Gastric histopathology in laparoscopic sleeve gastrectomy: Pre- and post-operative comparison. Obes Surg. 2014;24(3):371–6.
6. 6. Ge L, Moon RC, Nguyen H, de Quadros LG, Teixeira AF, Jawad MA. Pathologic findings of the removed stomach during sleeve gastrectomy. Surg Endosc. 2019 Feb 15:1–5
7. 7. Vrabie CD, Cojocaru M, Waller M, Sindelaru R, Copaescu C. The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Medical Journal/Dicle Tip Dergisi. 2010 Jun 1;37(2).
8. 8. Schirmer B, Schauer PR. The surgical management of obesity. In: Brunicardi F, Andersen D, Hunter J, et al., editors. Schwartz’s principles of surgery in the dition. USA: McGraw-Hill Companies; 2010. p. 952–3. In: Brunicardi F, Andersen D, Hunter J, et al., editors, editor. Schwartz’s principles of surgery; 2016. 952–3 p.

9. 9. Ohanessian SE, Rogers AM, Karamchandani DM. Spectrum of gastric histopathologies in severely obese american patients undergoing sleeve gastrectomy. Obes Surg. 2016;26(3):595–602.
10. 10. AbdullGaffar B, Raman L, Khamas A, AlBadri F. Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens? Obes Surg. 2016;26(1):105–10.
11. 11. Clapp B. Histopathologic findings in the resected specimen of a sleeve gastrectomy. JSLS. 2015;19(1):e2013.00259.
12. 12. Raess PW, Baird-Howell M, Aggarwal R, Williams NN, Furth EE. Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management. Surg Obes Relat Dis Off J Am Soc Bariatr Surg. 2015;11(5):1020–3.
13. 13. 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.
14. 14. Lauti M, Gormack SE, Thomas JM, Morrow JJ, Rahman H, MacCormick AD. What Does the Excised Stomach from Sleeve Gastrectomy Tell us? Obes Surg. 2016;26(4):839–42.
15. 15. 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(12):2134–7.
16. 16. Kinsinger LA, Garber JC, Whipple O. A Review of sleeve gastrectomy specimen histopathology. Am Surg. 2016 Nov 1;82(11):1101–4.
17. 17. Chiappetta S, Theodoridou S, Stier C, Weiner RA. Incidental finding of GIST during obesity surgery. Obes Surg. 2015;25(3):579–83.
18. 18. Tryggvason G, Gíslason HG, Magnússon MK, Jónasson JG. Gastrointestinal stromal tumors in Iceland, 1990-2003: the icelandic GIST study, a population-based incidence and pathologic risk stratification study. Int J Cancer. 2005;117(2):289–93.
19. 19. Safaan T, Bashah M, El Ansari W, Karam M. Histopathological changes in laparoscopic sleeve gastrectomy specimens: Prevalence, risk factors, and value of routine histopathologic examination. Obes Surg. 2017;27(7):1741–9.
20. 20. Yamamoto S, Watabe K, Takehara T. Is obesity a new risk factor for gastritis? Digestion. 2012;85(2):108–10.
21. 21. Masrur M, Bustos R, Sanchez-Johnsen L, et al. Factors associated with weight loss after metabolic surgery in a multiethnic sample of 1012 patients. Obes Surg. 2019;1–7.
22. 22. Erkinuresin T, Demirci H, Cayci HM, Erdogdu UE. The relationship between histopathologic findings and weight loss in laparoscopic sleeve gastrectomy. Obes Surg. 2019; 1–5.
23. 23. Suerbaum S, Michetti P. Helicobacter pylori Infection. N Engl J Med. 2002;347(15):1175–86.
24. 24. Khedmat H, Karbasi-Afshar R, Agah S, Taheri S. Helicobacter pylori Infection in the general population: A Middle Eastern perspective. Casp J Intern Med. 2013;4(4):745–53.
25. 25. Eshraghian A. Epidemiology of Helicobacter pylori infection among the healthy population in Iran and countries of the Eastern Mediterranean Region: a systematic review of prevalence and risk factors. World J Gastroenterol. 2014;20(46):17618–25.
26. 26. Khalilpour A, Kazemzadeh-Narbat M, Tamayol A, Oklu R, Khademhosseini A. Biomarkers and diagnostic tools for detection of Helicobacter pylori. Appl Microbiol Biotechnol. 2016;100(11):4723–34.
27. 27. 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.
28. 28. Carabotti M, D’Ercole C, Iossa A, Corazziari E, Silecchia G, Severi C. Helicobacter pylori infection in obesity and its clinical outcome after bariatric surgery. World J Gastroenterol. 2014;20(3):647–53.
29. 29. Leung WK, Ng EKW, Chan WY, Auyeung ACM, Chan K-F, Lam CCH, et al. Risk factors associated with the development of intestinal metaplasia in first-degree relatives of gastric cancer patients. Cancer Epidemiol Biomark Prev Publ Am Assoc Cancer Res Cosponsored Am Soc Prev Oncol. 2005;14(12):2982–6.
30. 30. Chen XY, Liu WZ, Shi Y, Zhang DZ, Xiao SD, Tytgat GNJ. Helicobacter pylori associated gastric diseases and lymphoid tissue hyperplasia in gastric antral mucosa. J Clin Pathol. 2002;55(2):133–7.