Khattak Muhammad Ali, Rafique Ahmed Muhammad, Iqbal Yasir, Abdulrasheed Habeeb, Khan Muhammad Usman, Malik Amman
Urology, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Surgery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, GBR.
Cureus. 2024 Sep 18;16(9):e69666. doi: 10.7759/cureus.69666. eCollection 2024 Sep.
Laparoscopic sleeve gastrectomy (LSG) is a widely performed bariatric surgery that involves the removal of a portion of the stomach. Routinely, the resected gastric tissue is sent for histopathological examination to screen for malignancies or other significant pathological findings. However, the necessity of this routine practice remains uncertain. This study aims to evaluate the histopathological outcomes of LSG specimens over a five-year period at our institution.
We conducted a retrospective analysis of 203 patients who underwent LSG between January 2017 and December 2022 at Heartlands Hospital, University Hospitals Birmingham. Data collected included patient demographics, body mass index (BMI), use of preoperative oesophagogastroduodenoscopy (OGD), and histopathological findings. Patients with incomplete records or those who underwent Roux-en-Y gastric bypass were excluded from the study.
Data were extracted for 310 patients, of whom 107 were excluded. The majority of the 203 patients analyzed were female (83%), with a mean age of 45.7 years and a mean BMI of 45.4 ± 7.3. Preoperative OGD was performed in only 0.5% of cases. Histopathological examination revealed that 81.3% (n=165) of patients had normal gastric mucosa, while 14.3% (n=29) had chronic gastritis. Clinically significant findings were rare, with only 1% (n=2) of patients showing gastrointestinal stromal tumors (GISTs) or focal intestinal metaplasia. None of the patients required additional treatment or follow-up based on these histopathological findings.
Most LSG specimens in our study showed normal or non-significant histopathological findings, raising questions about the routine use of histopathological examination in LSG procedures. It remains unclear whether histopathology is necessary following sleeve gastrectomy. While no patients in our cohort required further treatment or surveillance, there are reports in the literature where surveillance or further treatment was necessary, though the incidence remains low. Given the low incidence of clinically significant pathology, further studies with larger sample sizes and multi-center data are needed to establish clear guidelines on this issue.
腹腔镜袖状胃切除术（LSG）是一种广泛开展的减肥手术，需要切除部分胃组织。通常，切除的胃组织会送去做组织病理学检查，以筛查恶性肿瘤或其他重要的病理发现。然而，这种常规做法的必要性仍不确定。本研究旨在评估我院五年间LSG标本的组织病理学结果。
我们对2017年1月至2022年12月在伯明翰大学医院心脏地带医院接受LSG手术的203例患者进行了回顾性分析。收集的数据包括患者人口统计学信息、体重指数（BMI）、术前食管胃十二指肠镜检查（OGD）的使用情况以及组织病理学发现。记录不完整的患者或接受了 Roux-en-Y 胃旁路手术的患者被排除在研究之外。
提取了310例患者的数据，其中107例被排除。分析的203例患者中大多数为女性（83%），平均年龄45.7岁，平均BMI为45.4±7.3。仅0.5%的病例进行了术前OGD。组织病理学检查显示，81.3%（n = 165）的患者胃黏膜正常，而14.3%（n = 29）有慢性胃炎。具有临床意义的发现很少见，只有1%（n = 2）的患者表现为胃肠道间质瘤（GIST）或局灶性肠化生。基于这些组织病理学发现，没有患者需要额外的治疗或随访。
我们研究中的大多数LSG标本显示正常或无显著的组织病理学发现，这引发了对LSG手术中常规使用组织病理学检查的质疑。袖状胃切除术后组织病理学是否必要仍不清楚。虽然我们队列中的患者均无需进一步治疗或监测，但文献中有报告称需要进行监测或进一步治疗，尽管发生率仍然很低。鉴于具有临床意义的病理学发生率较低，需要进行更大样本量和多中心数据的进一步研究，以就此问题建立明确的指南。
