title: Histopathological Changes in Laparoscopic Sleeve Gastrectomy Specimens: Prevalence, Risk Factors, and Value of Routine Histopathologic Examination.
abstract: Laparoscopic sleeve gastrectomy (LSG) is a common surgical therapeutic option for obese patients, with debate about the value of routine histopathologic examination of LSG specimens. We assessed the following: prevalence of different histopathologic changes in LSG specimens, risk factors associated with premalignant and with frequent histopathologic changes, and whether routine histopathologic examination is warranted for LSG patients with nonsignificant clinical history.
  
  
  
  Retrospective review of records of all LSG patients operated upon at Hamad General Hospital, Qatar (February 2011-July 2014, n = 1555), was conducted. Risk factors (age, BMI, gender, and Helicobacter pylori) were assessed in relation to specific abnormal histopathologic changes.
  
  
  
  Mean age and BMI of our sample were 35.5 years and 46.8, respectively. Females comprised 69.7% of the sample. Normal histopathologic specimens comprised 52% of the sample. The most common histopathologic changes were chronic inactive gastritis (33%), chronic active gastritis (6.8%), follicular gastritis (2.7%), and lymphoid aggregates (2.2%). We observed rare histopathology in 3.3% of the sample [e.g., intestinal metaplasia and gastrointestinal stromal tumor (GIST)]. Older age was associated with GIST and intestinal metaplasia (P = 0.001 for both). Females were associated with chronic active gastritis (P = 0.003). H. pylori infection was associated with follicular gastritis, lymphoid aggregates, GIST, intestinal metaplasia, and chronic active gastritis (P < 0.001 for each).
  
  
  
  Older age, H. pylori, and female gender are risk factors for several abnormal histopathologic changes. Histopathologic examination of LSG specimens might harbor significant findings; however, routine histopathologic examination of all LSG specimens, particularly in the absence of suggestive clinical symptoms, is questionable. The association between female gender and chronic active gastritis; and the association between H. pylori infection and GIST are both novel findings that have not been previously reported in the published literature.
authors.affiliation: Department of General Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar. tsaafan@gmail.com.
authors.forename: Tamer
authors.initials: T
authors.lastname: Safaan
authors.affiliation: Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
authors.forename: Moataz
authors.initials: M
authors.lastname: Bashah
authors.affiliation: Department of Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.|College of Medicine, Doha, State of Qatar|School of Health and Education, University of Skövde, Skövde, Sweden
authors.forename: Walid
authors.initials: W
authors.lastname: El Ansari
authors.affiliation: Department of Bariatric Surgery, Hamad General Hospital, Hamad Medical Corporation, Doha, State of Qatar.
authors.forename: Mohsen
authors.initials: M
authors.lastname: Karam
mesh_terms: D000328:Adult; D005260:Female; D005743:Gastrectomy; D006651:Histocytochemistry; D006801:Humans; D010535:Laparoscopy; D008297:Male; D009767:Obesity, Morbid / Q000453:epidemiology / Q000473:pathology* / Q000601:surgery; D015995:Prevalence; D012189:Retrospective Studies; D012307:Risk Factors; D013270:Stomach / Q000737:chemistry / Q000473:pathology / Q000601:surgery
keywords: GIST; H. pylori; Histopathologic examination; Intestinal metaplasia; Morbid obesity; Sleeve gastrectomy; Stomach