title: Should We Abandon Routine Microscopic Examination in Bariatric Sleeve Gastrectomy Specimens?
abstract: BACKGROUND
  Laparoscopic sleeve gastrectomy (LSG) is a relatively new bariatric surgical procedure to reduce weight in morbidly obese patients, with an overall low rate of complications and thus gaining a worldwide popularity. It provides an opportunity to study the pathology of the stomach in obese patients. Most studies, however, focused on clinical aspects, surgical techniques, and postoperative complications. Few authors studied the histopathologic findings. Whether routine histopathologic examination is warranted in patients with grossly unremarkable LSG specimens and nonsignificant clinical history was not previously studied.
  
  
  METHODS
  We conducted a prospective study over 8 years to compare the prevalence, the morphologic spectrum and importance of histopathologic findings, and the frequency of incidental neoplasms in LSG specimens with other studies. We also proposed a protocol for the gross handling and sectioning of LSG specimens.
  
  
  RESULTS
  We found 546 LSG specimens. Five patients developed iatrogenic postoperative complications, two of which pursued a medicolegal case. There was no association between the histopathologic findings and the complications. Less than 1 % of incidental benign lesions were found. No malignancies were identified. All of the patients without postoperative complications had uneventful outcome after 5 months to 6 years follow-up.
  
  
  CONCLUSIONS
  Routine microscopic examination of all LSG specimens is not necessary. Selective microscopic examination guided by relevant clinical history and macroscopic examination is a better option. This protocol will save money, time, and workload without compromising patient's safety and future management. However, a careful gross description is still necessary in certain cases for potential future medicolegal implications.
authors.affiliation: Pathology Section, Rashid Hospital, Oud Metha Road, Dubai, United Arab Emirates. badraah009@yahoo.com.
authors.forename: Badr
authors.initials: B
authors.lastname: AbdullGaffar
authors.affiliation: Histopathology Unit, Dubai Hospital, Dubai, United Arab Emirates.
authors.forename: Lakshmiah
authors.initials: L
authors.lastname: Raman
authors.affiliation: Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Ali
authors.initials: A
authors.lastname: Khamas
authors.affiliation: Surgery Unit, Rashid Hospital, Dubai, United Arab Emirates.
authors.forename: Faisal
authors.initials: F
authors.lastname: AlBadri
mesh_terms: D000293:Adolescent; D000328:Adult; D005260:Female; D005743:Gastrectomy; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008853:Microscopy; D008875:Middle Aged; D009767:Obesity, Morbid / Q000601:surgery; D011183:Postoperative Complications; D011446:Prospective Studies; D013270:Stomach / Q000473:pathology*; D019564:Unnecessary Procedures; D015431:Weight Loss; D055815:Young Adult
keywords: Macroscopic examination; Microscopic examination; Morbid obesity; Sleeve gastrectomy; Stomach