title: What Does the Excised Stomach from Sleeve Gastrectomy Tell us?
abstract: BACKGROUND
  Staple-line leak and haemorrhage are the most serious complications following sleeve gastrectomy. The operation is often performed without prior endoscopy. Given that gastric inflammatory conditions are common, could they predispose patients to suffering a serious complication following sleeve gastrectomy?
  
  
  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 haemorrhage. Associations were explored using Fisher's exact test.
  
  
  RESULTS
  Over this period, 976 laparoscopic sleeve gastrectomies were performed with a pre-operative gastroscopy rate of 2.2%. Over half of the specimens demonstrated a histopathologic abnormality. Helicobacter pylori infection occurred in 8.6%, and the most common histopathologic abnormality was chronic gastritis in 38.9%. There was no association between H. pylori infection or inflammation and staple-line leak and/or haemorrhage.
  
  
  CONCLUSIONS
  We conclude that inflammatory gastric conditions are unlikely to predispose patients to staple-line leaks or haemorrhages following sleeve gastrectomy and that selective pre-operative gastroscopy may be an appropriate standard of care.
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand. m.lauti@auckland.ac.nz.
authors.forename: Melanie
authors.initials: M
authors.lastname: Lauti
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.
authors.forename: Sophie E
authors.initials: SE
authors.lastname: Gormack
authors.affiliation: Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Jeni M
authors.initials: JM
authors.lastname: Thomas
authors.affiliation: Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Jon J
authors.initials: JJ
authors.lastname: Morrow
authors.affiliation: Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Habib
authors.initials: H
authors.lastname: Rahman
authors.affiliation: Department of Surgery, University of Auckland, Auckland, New Zealand.|Department of General Surgery, Middlemore Hospital, Counties Manukau Health, Auckland, New Zealand.
authors.forename: Andrew D
authors.initials: AD
authors.lastname: MacCormick
mesh_terms: D057868:Anastomotic Leak / Q000209:etiology; D005743:Gastrectomy / Q000009:adverse effects*; D005756:Gastritis / Q000150:complications; D005773:Gastroscopy; D016481:Helicobacter Infections / Q000150:complications; D006801:Humans; D010535:Laparoscopy; D009767:Obesity, Morbid / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000209:etiology; D011300:Preoperative Care; D012189:Retrospective Studies; D013270:Stomach / Q000473:pathology* / Q000601:surgery; D013272:Stomach Diseases / Q000150:complications; D017792:Surgical Stapling / Q000009:adverse effects
keywords: Bariatric surgery; Helicobacter pylori; Pre-operative gastroscopy; Sleeve gastrectomy; Surgical complications