Histologic and Cost-Benefit Analysis of Laparoscopic Sleeve Gastrectomy Specimens Performed for Morbid Obesity
| Autor: | Fayez A. Quereshy, Adam Di Palma, Stefano Serra, Allan Okrainec, Runjan Chetty, Klaudia M. Nowak, Tim Jackson, Kenny Chieu |
|---|---|
| Rok vydání: | 2020 |
| Předmět: |
Adult
Male medicine.medical_specialty Helicobacter pylori infection Cost-Benefit Analysis Bariatric Surgery Patient characteristics 030209 endocrinology & metabolism Helicobacter Infections Pathology and Forensic Medicine Morbid obesity 03 medical and health sciences Broad spectrum 0302 clinical medicine Gastrectomy medicine Humans Sampling (medicine) Ontario Laparoscopic sleeve gastrectomy Helicobacter pylori business.industry Gross Pathologic Examination General Medicine Middle Aged Gastric remnant Obesity Morbid Medical Laboratory Technology Female Laparoscopy 030211 gastroenterology & hepatology Radiology business |
| Zdroj: | Archives of Pathology & Laboratory Medicine. 145:365-370 |
| ISSN: | 1543-2165 0003-9985 |
| DOI: | 10.5858/arpa.2020-0084-oa |
| Popis: | Context.— Laparoscopic sleeve gastrectomy (LSG) has quickly become the bariatric surgical procedure of choice for patients with obesity who have failed medical management. Laparoscopic sleeve gastrectomy results in a gastric remnant that is routinely subject to pathologic examination. Objective.— To perform a histologic and cost-benefit analysis of gastric remnants post-LSG. Design.— All LSG cases performed at University Health Network, Toronto, Ontario, Canada, between 2010 and 2019 were reviewed. Specimens that underwent routine histopathologic assessment and ancillary immunohistochemical analysis were analyzed. Baseline patient characteristics and surgical outcomes were obtained from our internal database. The total cost of specimen gross preparation, examination, sampling, and producing and reporting a hematoxylin-eosin slide was calculated. Results.— A total of 572 patients underwent LSG during the study period and had their specimens examined histologically. A mean of 4.87 blocks generating 4 hematoxylin-eosin slides was produced. The most common histologic findings reported in LSG specimens ranged from no pathologic abnormalities identified together with proton pump inhibitor–related change. A minority of cases demonstrated clinically actionable histologic findings, of which Helicobacter pylori infection was the most common. The total cost for the complete pathologic analysis of these cases amounted to CaD $66 383.10 (US $47 080.21) with a mean of CaD $116.05 (US $82.40) per case. A total of CaD $62 622.75 (US $44 413.30) was spent on full examination of cases that had no further postoperative clinical impact. Conclusions.— There is a broad spectrum of pathologic findings in LSG specimens, ranging from clinically nonactionable to more clinically actionable. The vast majority of histologic findings had no clinical impact, with only a minority of cases being clinically significant. This study therefore recommends that LSG specimens be subject to gross pathologic examination in the vast majority of cases. However, sections should be submitted for microscopic analysis if grossly evident lesions are present and if there is a clinical/known history of clinically actionable findings. |
| Databáze: | OpenAIRE |
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