M. Lauti1, J. M. Thomas1, J. J. Morrow1, H. Rahman1, A. D. MacCormick1 1Middlemore Hospital, University Of Auckland,Auckland, Auckland, New Zealand
Introduction:
Upper endoscopy prior to bariatric surgery is the recommended standard. This may not be applicable to asymptomatic patients undergoing laparoscopic sleeve gastrectomy as the stomach is excised and the duodenum remains accessible. We hypothesise that routine pre-operative upper endoscopy is unnecessary in the asymptomatic bariatric patient undergoing sleeve gastrectomy. We also describe the histologic specimens in our series of sleeve gastrectomy patients and explore whether histologic diagnosis is associated with post-operative leak and/or bleed.
Methods:
Consecutive patients undergoing laparoscopic sleeve gastrectomy from March 2007 to May 2014 were included in the study. All final histologic reports were coded and investigated against whether or not the patient had a post-operative leak and/or bleed. Associations were tested using Chi-squared test.
Results:
Over this period, almost 1,000 laparoscopic sleeve gastrectomies were performed. Half of all specimens showed an abnormality. The distribution of histologic diagnoses can be seen in the chart below. There were no incidental findings of malignancy but 12% of specimens exhibited features of premalignant change. There were no associations between histologic diagnosis and post-operative leak and/or bleed.
Conclusion:
Although a histologic diagnosis is common in the resected stomach from a sleeve gastrectomy; it is not related to post-operative bleed and/or leak. Histologic examination of the resected stomach may aid in identifying patients at increased risk of adenocarcinoma in the remnant. It remains arguable whether routine gastroscopy is required in all pre-operative sleeve gastrectomy patients.
