Unexpected histopathological findings after sleeve gastrectomy

  • Adam Di Palma
  • Sultan Alhabdan
  • Azusa Maeda
  • Fabrizio Mattu
  • Runjan Chetty
  • Stefano Serra
  • Fayez Quereshy
  • Timothy Jackson
  • Allan OkrainecEmail author
2019 SAGES Oral



Laparoscopic sleeve gastrectomy (LSG) represents one of the most commonly performed bariatric procedures and, in contrast to the Roux-en-Y gastric bypass, produces a specimen for pathologic examination. This study aims to describe unexpected histopathological findings in order to better define preoperative management of patients undergoing LSG.


All LSG cases performed at an academic center in Toronto, Ontario between 2010 and 2017 were reviewed. All specimens underwent histopathological assessment, while those with findings suspicious for neoplasia or the presence of Helicobacter pylori underwent additional immunohistochemical stainings. Baseline patient characteristics and surgical outcomes were obtained from our internal database.


A total of 222 patients underwent LSG during the study period and had their specimens examined histologically. Among them, 22.5% underwent preoperative endoscopy. The most common histopathological diagnosis was no abnormal findings (50.9%) followed by gastritis (25.7%). Abnormal findings warranting a change in postoperative management or follow-up were discovered in 8.6% of specimens and included H. pylori infection, intestinal metaplasia, malignancy, and atrophic gastritis. Only 4.7% of all patients had not undergone preoperative endoscopy and had truly unexpected findings. No significant association was found between abnormal findings and age, sex, or baseline body mass index (BMI).


Although a majority of patients had a gastric specimen within normal limits, 8.6% had findings requiring a change in postoperative management. This rate dropped to 4.7% when patients whose diagnoses were known preoperatively were excluded. Our findings suggest that further research is needed to better define the role of preoperative endoscopy to potentially reduce the number of unexpected findings following LSG.


Bariatric surgery Sleeve gastrectomy Incidental finding Endoscopy Neoplasia Helicobacter pylori 



This study received no outside financial support.

Compliance with ethical standards


Dr. Di Palma reports grants from Medtronic outside the submitted work. Dr. Okrainec reports personal fees from Medtronic, personal fees from Ethicon, personal fees from Merck, outside the submitted work. Drs. Alhabdan, Maeda, Mattu, Chetty, Serra, Quereshy and Jackson have no conflicts of interest or financial ties to disclose.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Adam Di Palma
    • 1
  • Sultan Alhabdan
    • 1
  • Azusa Maeda
    • 1
  • Fabrizio Mattu
    • 2
  • Runjan Chetty
    • 2
    • 3
  • Stefano Serra
    • 2
    • 3
  • Fayez Quereshy
    • 1
    • 4
  • Timothy Jackson
    • 1
    • 4
  • Allan Okrainec
    • 1
    • 4
    • 5
    Email author
  1. 1.Division of General SurgeryUHNTorontoCanada
  2. 2.Department of PathologyUHNTorontoCanada
  3. 3.Department of Laboratory Medicine and Pathology, Faculty of MedicineUniversity of TorontoTorontoCanada
  4. 4.Department of Surgery, Faculty of MedicineUniversity of TorontoTorontoCanada
  5. 5.Toronto Western Hospital, University Health NetworkTorontoCanada

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