title: Vertical sleeve gastrectomy specimens have a high prevalence of unexpected histopathologic findings requiring additional clinical management.
abstract: BACKGROUND
  Laparoscopic vertical sleeve gastrectomy is used with increasing frequency as a therapeutic option for morbid obesity. Before the procedure, patients undergo a rigorous preoperative evaluation including double contrast upper gastrointestinal radiographic series at our institution. Patients undergoing sleeve gastrectomy are presumed to have no significant gastric pathology.
  
  
  OBJECTIVE
  To investigate the prevalence of histopathologic findings requiring clinical follow-up in sleeve gastrectomy specimens.
  
  
  METHODS
  University Hospital, United States.
  
  
  METHODS
  Retrospective review was conducted of all primary vertical sleeve gastrectomy specimens performed for morbid obesity at our institution from July 2008 until August 2012 (N = 248).
  
  
  RESULTS
  Unanticipated findings warranting clinical follow-up were identified in 8.4% of cases and included cases of H. pylori gastritis, autoimmune gastritis with microcarcinoid formation, necrotizing vasculitis, and intestinal metaplasia. H. pylori was identified in 5.2% of all cases and in 33.3% of cases of gastritis. Neoplasms were identified at laparoscopy in 2 additional cases (0.8%).
  
  
  CONCLUSIONS
  Surgeons and pathologists should be aware of the high prevalence of diagnoses requiring clinical follow-up in vertical sleeve gastrectomy specimens.
authors: Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Philipp W
authors: PW
authors: Raess
authors: Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Marilyn
authors: M
authors: Baird-Howell
authors: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Rajesh
authors: R
authors: Aggarwal
authors: Department of Surgery, University of Pennsylvania, Philadelphia, Pennsylvania.
authors: Noel N
authors: NN
authors: Williams
authors: Department of Pathology and Laboratory Medicine, University of Pennsylvania, Philadelphia, Pennsylvania. Electronic address: eef@mail.med.upenn.edu.
authors: Emma E
authors: EE
authors: Furth
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000009:adverse effects / Q000379:methods; D015992:Body Mass Index; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D005743:Gastrectomy / Q000009:adverse effects / Q000379:methods*; D005756:Gastritis / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D016481:Helicobacter Infections / Q000453:epidemiology / Q000473:pathology / Q000628:therapy; D006785:Hospitals, University; D006801:Humans; D033162:Incidental Findings; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods; D008297:Male; D008875:Middle Aged; D009767:Obesity, Morbid / Q000473:pathology* / Q000601:surgery*; D011300:Preoperative Care / Q000379:methods; D015995:Prevalence; D012189:Retrospective Studies; D013048:Specimen Handling; D013270:Stomach / Q000473:pathology*; D016896:Treatment Outcome; D014481:United States
keywords: Pathologic findings; Sleeve gastrectomy; Unexpected follow-up