# Histopathological Analysis Post Sleeve Gastrectomy: Value and Correlation With Preoperative Endoscopic Findings

## TL;DR

This study examines the usefulness of histopathological analysis after sleeve gastrectomy and finds it rarely detects significant issues already seen in preoperative endoscopies.

## Contribution

The study provides empirical evidence on the limited added value of routine histopathological analysis after sleeve gastrectomy.

## Key findings

- Only 0.7% of patients had premalignant lesions detected via histopathology not seen in preoperative endoscopies.
- Malignancies were not detected in any of the 908 patients studied.
- Routine histopathological analysis may not be necessary due to low prevalence of significant findings.

## Abstract

Background

Laparoscopic sleeve gastrectomy (LSG) is one of the most common bariatric surgical procedures performed today. Before LSG, patients undergo an endoscopic examination to assess for any significant pathology that could affect the surgical outcome. Following LSG, the resected stomach tissue is routinely submitted for histopathological analysis, though the practice's efficacy remains debated. Furthermore, formal guidelines and recommendations for this practice are lacking.

Methodology

This retrospective single-center analysis was conducted at King Fahad Specialist Hospital (KFSH) in Buraydah, Al-Qassim. Following ethical approval, all patients with obesity who underwent LSG at our institution between 2017 and 2024 and whose medical records contained complete data were included in this study. Patient data meeting the inclusion criteria were then collected through a review of medical records. Data were collected using a standardized collection sheet.

Results

This study included 908 patients with obesity. Of the 908 patients, 547 (60.2%) were female and 361 (39.8%) were male. The vast majority, 893 (98.3%), were Saudi nationals. Participants had a mean age of 35.16 ± 13.049 years and a mean BMI of 44.08 ± 7.095 kg/m2. Preoperative gastroscopy revealed no mucosal abnormalities, ulcers, polyps, or vascular lesions in 421 patients (99.3%). Histopathological examination (HPE) of the resected tissue identified premalignant lesions in three patients (0.7%), with no malignancies detected.

Conclusions

This study highlights the value of HPE and its correlation with preoperative endoscopic findings in patients undergoing LSG. Given the low prevalence of malignancy, routine HPE may not be warranted. Therefore, HPE should be considered selectively to reduce costs and effort.