Clinical Effectiveness of Routine Pathological Exam after Bariatric Laparoscopic Sleeve Gastrectomy


Obesity gathered global pandemic dimensions, affecting patients of all ages A strong association between obesity, serious comorbidities (type 2 diabetes, cardiovascular disease, musculoskeletal disorders and certain cancers) and an increased risk of premature mortality was clearly demonstrated .Weight loss improves both morbidity and mortality of obese patients but achieving significant and sustained results over time using conservative strategies is not easy.

Bariatric surgery is, to date, the most successful long-term treatment for obesity. Surgical interventions improve both weight and obesity comorbidities in a fast and durable manner. Between many available surgical procedures, Laparoscopic Sleeve Gastrectomy (LSG) is widely adopted because of good efficacy and safety profile.

With the introduction of laparoscopic techniques, the number of bariatric interventions increased dramatically. Because of high costs and the increased number of interventions, a serious burden is posed over healthcare budgets. Many associated medical specialties that relate to the bariatric surgery are under scrutiny, in order to control geometrically increasing intervention costs. Routine histologic exam of the gastric samples is one of these. Bariatric surgery is performed in order to reduce weight and patients usually do not have complex pathology associated - the clinically relevant information provided is scarce (same category as appendectomies or simple cholecystectomies). Based on legal demands and historical experience it is customary that a pathologist should examine every surgical specimen. Some opinions considered a complete anatomic pathology exam as unnecessary and (in most of cases) at least the routine microscopy should be abandoned. Others still consider microscopic examination of the gastric wall as relevant and recommend histopathology as a key diagnostic tool that may influence patients’ post operatory care.

The objective of our research was to evaluate the clinical effectiveness of the routine histology exam of gastric wall specimens sampled after LSG performed in a general surgery unit over 4 years.

In our experience, routine pathology exam is effective in detecting histology diagnostics with clinical significance after LSG. Nonbariatric surgical centers working with patients with medico-surgical risk, with specific populations and where more sophisticated diagnostic procedures are not available for different reasons should maintain histology as “gold standard” after all bariatric surgical interventions.

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