Sleeve Gastrectomy Specimens Research Articles

Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management

BackgroundLaparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Before the procedure, patients undergo a rigorous preoperative evaluation including double contrast upper gastrointestinal radiographic series at our institution. Patients undergoing sleeve gastrectomy are presumed to have no significant gastric pathology. Objectives: To investigate the prevalence of histopathologic findings requiring clinical follow-up in sleeve gastrectomy specimens. Setting: University Hospital, United States. MethodsRetrospective review was conducted of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (N = 248). ResultsUnanticipated findings warranting clinical follow-up were identified in 8.4% of cases and included cases of H. pylori gastritis, autoimmune gastritis with microcarcinoid formation, necrotizing vasculitis, and intestinal metaplasia. H. pylori was identified in 5.2% of all cases and in 33.3% of cases of gastritis. Neoplasms were identified at laparoscopy in 2 additional cases (0.8%). ConclusionsSurgeons and pathologists should be aware of the high prevalence of diagnoses requiring clinical follow-up in vertical sleeve gastrectomy specimens.

43. The pathology of gastric sleeve resections for weight loss

Background As a treatment for morbid obesity, the number of sleeve gastrectomy operations performed has increased markedly over the last five years. Patients undergoing this operation usually have minimal or no preoperative gastric investigations. There is scant data available on the pathology seen sleeve gastrectomy specimens and whether pre-operative investigations would be warranted to ensure serious disorders are managed appropriately. Aims To determine the frequency of various pathologies present in gastric sleeve bypass specimens. Methods A retrospective analysis of a consecutive series of sleeve gastrectomies, performed for weight loss, was conducted. The specimens were collected from both a Private (586 cases) and Public (214 cases) Pathology Service between 2000 and 2014. Results and conclusions The series included 800 sequential cases and 74% were female. Abnormal findings were seen in 203 cases (25.4%). The most commonly seen pathology was non-specific, non-Helicobacter associated gastritis (86 cases, 10.75%). Helicobacter associated gastritis was seen in 53 cases (6.3%). Other common pathologic findings were benign polyps (fundic gland polyps and hyperplastic polyps) in 37 cases, proton pump inhibitor changes in 7 cases, and lymphocytic gastritis pattern of inflammation in 7 cases. There were also rare examples of autoimmune gastritis, gastrointestinal stromal tumour, pancreatic heterotopia, gastric atrophy, vascular ectasia and a sarcoma. This series has shown that the vast majority of sleeve gastrectomies show either normal histology or benign changes. Based on this series, it would appear that the use of pre-operative investigations is unwarranted.

The effects of reinforcement methods on burst pressure in resected sleeve gastrectomy specimens.

Staple-line leak is a life-threatening complication of laparoscopic sleeve gastrectomy. Reinforcement materials have been reported to lower the risk of staple-line bleeding, but their effects on leak risk have not been elucidated. The aim of this study was to compare the effects of two supportive techniques on burst pressures in sleeved gastrectomy specimens. Thirty patients who underwent laparoscopic sleeve gastrectomy were evaluated. The resected sleeve gastrectomy specimens were categorized into three groups. Group 1 had no extra support in the staple line, Group 2 had oversewing with continuous suture on the staple line, and Group 3 had fibrin sealant (Tisseel(®); Baxter, Deerfield, IL) on the staple line. The end point was the first detectable leakage, at which point leak pressure and the anatomic site of leakage were recorded. Thirty sleeved gastrectomy specimens were included (each group included 10 specimens). There were no differences among group in terms of age, sex, and body mass index. The leak pressure was significantly higher (106±10.5 mm Hg) in Group 2 (P<.01). Leaks occurred significantly more frequently in the staple line than in the staple junction points (P=.014). Oversewing the staple line with 3-0 Vicryl(®) (Ethicon, Somerville, NJ) suture significantly increased the strength of the staple line. Increases in intraluminal pressure are known to be one of the significant risks in leak etiology. Thus, we concluded that oversewing the staple line with 3-0 Vicryl suture can be beneficial in the prevention of leaks. However, further work is necessary in this area of research.

Erratum to: Human tissue thickness measurements from excised sleeve gastrectomy specimens

Erratum to: Human tissue thickness measurements from excised sleeve gastrectomy specimens

Human tissue thickness measurements from excised sleeve gastrectomy specimens

Little basic science data exists regarding the thickness of transected stomach as the limits of smaller gastric sleeves are created closer to the lesser curvature in laparoscopic sleeve gastrectomy (SG). We sought to determine the tissue thickness trends along the staple line and examine what factors might predispose to thicker tissue. This was a single-center, single-surgeon nonrandomized prospective study of patients undergoing SG. Excised SG specimens, with patient consent, underwent tissue measurement at multiple predetermined locations and at the midpoint of each fired staple cartridge. After 9 months, ending in July 2012, we met our goal enrollment of 50 gastric sleeve specimens. Most of the patients were female (80 %) and white (92.5 %). Average age was 42 years (range, 19-60 years), and average body mass index (BMI) was 49 kg/m(2) (range, 34-82 kg/m(2)). Tissue thickness was significantly different (p < 0.01) at each location, with the antrum being the thickest at 2.70 mm, followed by the midbody at 2.33 mm, and the fundus at 1.97 mm. Both male gender (+0.32 mm, p = 0.04) and BMI over 50 kg/m(2) (+0.33 mm, p < 0.01) were associated with thicker tissue, but only in the antrum. The most significant transitions in thickness occurred on the fourth and fifth staple fires, dropping 0.24 mm (p = 0.02) and 0.35 mm (p < 0.01), respectively. Tissue thickness of excised SG specimens varies on the basis of location with the antrum being the thickest. Both BMI (>50 kg/m(2)) and gender (male) are associated with increased tissue thickness, but only in the antrum. Surgeons should consider using a thicker staple load, such as black, when these factors are present. Also, significant changes in tissue thickness at the fourth and fifth staple fires suggest stepwise alteration in staple cartridge color selection.

Nécrose cutanée du coude

Sleeve gastrectomy (SG) is quickly becoming the preferred procedure for bariatric surgery. According to the American Society for Metabolic and Bariatric Surgery guidelines, routine preoperative upper gastrointestinal endoscopies are not recommended universally for bariatric surgery. Some studies have shown that the histologic examination of SG specimens is insignificant and not a cost-effective practice. However, some speculate SG examination may unveil pertinent findings and prevent further progression of precursor lesions.This study aims to explore the clinically significant or actionable lesions that can be revealed with SG examination.Tufts Medical Center, Boston, USA.We analyzed 511 SG specimens obtained during bariatric surgery. Incidental findings were grouped in 2 categories: clinically significant/actionable and minor lesions. The clinically significant lesions accounted for 5.8%. This category included 5 cases of gastrointestinal stromal tumor; one case of MALT lymphoma; 4 cases of autoimmune gastritis with concomitant pancreatic metaplasia or neuroendocrine dysplasia. Intestinal metaplasia without dysplasia was identified in 3 cases; 14 cases of Helicobacter pylori associated active gastritis; 1 case of iron pill induced gastritis and 1 case of gastric glandular siderosis. The minor lesions accounted for 6.3%, showing findings other than chronic gastritis. This category included 19 cases of fundic polyps and 1 case of hyperplastic polyp; one case of leiomyoma; 11 cases of H pylori negative active gastritis.The majority of histopathology results after SG showed no significant changes. However, a few cases had clinically significant lesions in seemingly healthy patients, altering patient’s postoperative management.