Sleeve gastrectomy (SG) is the most commonly performed bariatric operation and the resected stomach is routinely sent to pathology for gross and microscopic evaluation. The percentage of specimens with significant abnormalities is low and can usually be detected by gross examination and therefore routine microscopic analysis may not justify the cost.
This is a retrospective review of a prospectively maintained database. IRB approval was obtained. All SGs performed from October 2010 to June 2019 were evaluated. Currently all specimens are submitted for gross and histopathologic examination along with determination of Helicobacter pylori status. Pathology reports were reviewed for abnormal gross or microscopic findings. A Fisher exact test was performed to determine if there was any relationship between abnormal pathology and major postoperative complications.
There were 288 SG specimens. The average age was 50.8 (25-68) years and the average BMI was 42.7 (33-65). Five (1.7%) gastrointestinal stromal tumors were identified and all were grossly detectable at the time of resection. There were no incidentally found adenocarcinomas or other malignancies. The majority of the pathology reports were normal (47.9%). Other findings included: chronic gastritis/inflammation (43.1%), H. pylori (23%), benign lymphoid aggregates (2.8%), fundic gland polyp (2.8%), mild surface degeneration (2.1%), active gastritis (1.4%), focal congestion (1.4%), focal intestinal metaplasia (1%), congested lamina propria (0.4%), and mucosa hyperplasia (0.4%). Fisher exact test was performed and found no relationship between the pathology results and any major post-operative complications.
Gross examination of SG specimens should always be performed. However, microscopic histopathology can be safely eliminated unless indicated by abnormal gross pathology. This approach would result in significant health care savings and not impact complication rates or postoperative care of the bariatric patient.