Macroscopic Evaluation of Gastric Specimens After Laparoscopic Sleeve Gastrectomy-an Optimum Screening Test for Incidental Pathologies?

Abstract:

INTRODUCTION:Obesity is a serious lifestyle disease with various comorbidities and an augmented risk of cancer. Laparoscopic sleeve gastrectomy (LSG) has recently become the most popular bariatric procedure worldwide. While the cost-effectiveness is a major healthcare providers' concern, the point of histological exam of each resected tissue may be questioned. MATERIAL/METHODS:We prospectively included patients who underwent LSG. Before the surgery, gastroscopy and abdominal sonography were performed to exclude malignancies. The gastric specimen was cut open after the surgery and inspected macroscopically, then sent for a microscopic examination. RESULTS:In 5 cases out of 115, macroscopic evaluation of the resected specimen performed by the surgeon suggested existing pathology, confirmed by a microscopic evaluation in 3 out of 5 cases. In the remaining 2 cases, pathological analysis did not reveal abnormalities. In 110 cases, the gastric specimen was recognized to be unchanged by the surgeon, 109 out of which were confirmed by the pathologist to be normal, in 1 case a hyperplastic polyp was found. The sensitivity of macroscopic evaluation reached 75% (95% CI, 19.4-99.4%, p = 0.625), with specificity of 98.2% (95% CI, 93.6-99.8%, p < 0.0001), and negative predictive value of 99.1% (95% CI, 95-99.9%, p < 0.0001). CONCLUSIONS:During LSG, a thorough visual inspection of the peritoneal cavity along with a macroscopic surgical evaluation of specimen in patients who had preoperative endoscopy with no findings allows to achieve very good specificity and good sensitivity. Therefore, this procedure may be useful as a screening test for incidental pathologies in bariatric patients and may exclude unnecessary histological examination.

journal_name

Obes Surg

journal_title

Obesity surgery

authors

Walędziak M,Różańska-Walędziak A,Janik MR,Paśnik KW,Kowalewski PK

doi

10.1007/s11695-018-3485-4

subject

Has Abstract

pub_date

2019-01-01 00:00:00

pages

28-31

issue

1

eissn

0960-8923

issn

1708-0428

pii

10.1007/s11695-018-3485-4

journal_volume

29

pub_type

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