SJLA_2024_A11: Histopathologic Evaluation of Tissue Resected Postsleeve Gastrectomy, to be done or Not?
Authors: Al-Hinai Reham , AlAbri Mohammed , Al-Badi Majid 
Published: September 2024

Introduction:
Obesity is one of the major lifestyle diseases and is associated with multiple comorbidities such as type 2 diabetes mellitus, hypertension, dyslipidemia, obstructive sleep apnea, and neoplasms. Bariatric surgeries are the most effective treatment for obesity. The cost-effectiveness of bariatric surgeries has become a major concern, and there is a shift toward avoiding histological evaluation of surgical specimens during routine procedures.

Background:
It is assumed that similar to other elective surgery specimens, gastrectomy specimens obtained in bariatric surgery would be normal, except for unexpected incidental findings. Here is a lack of published data on histopathological changes in gastric specimens from patients with morbid obesity. There are conflicting reports about the necessity of histopathological examination of bariatric surgery specimens. In Oman, the practice is to send all surgical specimens resected during sleeve gastrectomy for histopathologic evaluation despite in most of the centers, the practice is not to send in normal sleeve gastrectomy operations. Histopathological data are insufficient to describe the most common histopathological findings in laparoscopic sleeve gastrectomy specimens.

Methods:
All patients who underwent sleeve gastrectomy in Royal and Nizwa hospitals (tertiary hospitals in Oman) from January 2010 to December 2021 were included in the study. The data were collected from the medical records, and it includes baseline characteristics and histopathological findings. The data will be collected in Excel sheet. The analysis includes age, sex, body mass index (BMI), comorbidities, and the histopathological results.

Results:
The records of 759 patients were reviewed. 34.3% of the specimens were normal. The remaining of the specimens showed benign pathology. The most common benign pathologies were chronic gastritis 58.2%, H. Pylori-associated chronic gastritis 4.6 and chronic gastritis with metaplasia 1.7%.

Discussion:
This was a cross-sectional retrospective descriptive study. Statistical Package for the Social Science (SPSS) version 26 was used for analysis. Variables included age in years, sex, BMI, and histopathological findings were calculated as frequencies and percentages. Associations were assessed by t-test. P ≤ 0.05 was considered significant. The sample size was calculated using the n Master 2.0 calculator. Based on the expected common finding of chronic gastritis at 60%, 3.5%precision, and 95% confidence interval, we need to study a minimum of 753. The most prevalent histopathological finding is chronic gastritis 58.2%. This study’s results signify the null occurrence of malignancy in resected gastric specimens. There was no association between Helicobacter pylori and advanced age. There was no association between BMI and suspicious findings P value 0.293.

Conclusion:
The most prevalent histopathological finding is chronic gastritis. This study’s results signify the null occurrence of malignancy in resected gastric specimens. Routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms is not necessary. Finally, there is no association between BMI, gender, and age with suspicious findings.