The Importance of Routine Histopathological Examination in Laparoscopic Sleeve Gastrectomy Materials and the Role of Preoperative Upper Gastrointestinal Endoscopic Biopsy

Öz

Aim: Obesity is a life threatening epidemic worldwide. Laparoscopic sleeve gastrectomy is the most common primary bariatric procedure for the treatment of obesity. The aim of this study was to investigate the histopathological findings in laparoscopic sleeve gastrectomy materials, and to evaluate the relationship between histopathological findings and clinicopathological factors. In addition, to examine the histopathological findings in preoperative upper gastrointestinal endoscopic biopsies and frequency of upper gastrointestinal malignancy during the postoperative follow-up period. Material and Methods: A total of 650 patients who underwent laparoscopic sleeve gastrectomy between August 2017- August 2021 were analyzed retrospectively. Age, gender, body mass index, histopathology findings, and the number of sampled blocks were analyzed. Histopathological findings in preoperative upper gastrointestinal endoscopic biopsies were recorded. Follow-up data of the patients were evaluated to determine the incidence of upper gastrointestinal malignancy after sleeve gastrectomy. The Kolmogorov-Smirnov test was used to evaluate the assumption of normality in the data. Normal distribution continuous variables were compared using independent sample T-test, and Mann-Whitney U test for continuous variables with non-normal distribution. Chi-square test was used to compare proportions between groups. The P<0.05 was considered as statistically significant. Results: Four hundred seventy-one patients (72.5%) presented abnormal histopathological findings. The most common finding was chronic inactive gastritis. The rate of atrophic gastritis was 0.3%, the rate of Helicobacter pylori infection was 10.6%, and the rate of intestinal metaplasia was 1.8%. Preoperative upper gastrointestinal endoscopic biopsies were performed in 457 of 650 patients and the most common finding in biopsies was chronic inactive gastritis. No malignancies were identified in the postoperative follow-up. Conclusion: Routine evaluation of preoperative upper gastrointestinal endoscopic biopsies provide significant findings and can guide clinical management, however, careful macroscopic evaluation and histopathological examination should be performed on all sleeve gastrectomy materials to detect pathologies that may be overlooked.

Anahtar Kelimeler

• Sleeve Gastrectomy
• pathology
• obesity
• Helicobacter Pylori
• biopsy

Laparoskopik Sleeve Gastrektomi Materyallerinde Rutin Histopatolojik İncelemenin Önemi ve Preoperatif Üst Gastrointestinal Endoskopik Biyopsinin Rolü

Öz

Amaç: Obezite dünya çapında yaşamı tehdit eden bir salgındır. Laparoskopik sleeve gastrektomi obezite tedavisinde en sık uygulanan primer bariatrik prosedürdür. Bu çalışmanın amacı, laparoskopik sleeve gastrektomi materyallerinde histopatolojik bulguları araştırmak ve histopatolojik bulgular ile klinikopatolojik faktörler arasındaki ilişkiyi değerlendirmektir. Ayrıca ameliyat öncesi üst gastrointestinal endoskopik biyopsilerdeki histopatolojik bulguları ve ameliyat sonrası takip döneminde üst gastrointestinal malignite sıklığını incelemektir. Gereç ve Yöntemler: Ağustos 2017- Ağustos 2021 tarihleri arasında laparoskopik sleeve gastrektomi yapılan toplam 650 hasta retrospektif olarak incelendi. Yaş, cinsiyet, vücut kütle indeksi, histopatolojik bulgular ve örneklenen blok sayısı analiz edildi. Ameliyat öncesi üst gastrointestinal endoskopik biyopsilerde saptanan histopatolojik bulgular kaydedildi. Sleeve gastrektomi operasyonundan sonra gelişen üst gastrointestinal malignite insidansını belirlemek için hastaların takip verileri değerlendirildi. Verilerdeki normallik varsayımını değerlendirmek için Kolmogorov-Smirnov testi kullanıldı. Normal dağılım gösteren sürekli değişkenler, bağımsız örneklem T-testi ve normal dağılım göstermeyen sürekli değişkenler Mann-Whitney U testi kullanılarak karşılaştırıldı. Gruplar arasındaki oranları karşılaştırmak için ki-kare testi kullanıldı. P<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Dört yüz yetmiş bir hastada (%72,5) anormal histopatolojik bulgular saptandı. En sık görülen bulgu kronik inaktif gastritti. Atrofik gastrit oranı %0,3, Helikobakter pilori enfeksiyonu oranı %10,6 ve intestinal metaplazi oranı %1,8’di. 650 hastanın 457’sine ameliyat öncesi üst gastrointestinal endoskopik biyopsi yapılmıştı ve biyopsilerde en sık görülen bulgu kronik inaktif gastritti. Postoperatif takipte malignite saptanmadı. Sonuç: Ameliyat öncesi üst gastrointestinal endoskopik biyopsilerin rutin değerlendirilmesi önemli bulguların ortaya çıkarılmasını sağlar ve klinik yönetim hakkında da yol gösterebilir ancak gözden kaçabilecek patolojileri saptamak için tüm sleeve gastrektomi materyallerinde dikkatli makroskopik değerlendirme ve histopatolojik inceleme yapılmalıdır.

Anahtar Kelimeler

• Sleeve gastrektomi
• patoloji
• obezite
• Helikobakter pilori
• biyopsi

Kaynakça

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