|Year : 2015 | Volume
| Issue : 1 | Page : 18-20
Histopathology results of Jordanian patients after laparoscopic sleeve gastrectomy
Firas W Obeidat1, Awni D Shahait1, Hiba A Shanti1, Hashem M Al-Momani1, Sami A Abu Halaweh2
1 Department of General Surgery, The University of Jordan/Jordan University Hospital, Amman, Jordan
2 Department of Anesthesiology, The University of Jordan/Jordan University Hospital, Amman, Jordan
|Date of Web Publication||12-Jun-2015|
Firas W Obeidat
Queen Rania Street, P.O. Box 735, Amman 11953
Source of Support: None, Conflict of Interest: None
Background: Few studies have been published on histopathological findings in patients who underwent laparoscopic sleeve gastrectomy (LSG). However, no study has been published from Jordan, addressing the main histopathological findings for patients who underwent this procedure. Objective: This study aims to identify the patterns of gastric pathology among patients underwent laproscopic sleeve gastrectomy in Jordan. Materials and Methods: A retrospective review of histopathological results was performed for 150 patients who underwent LSG at Jordan University Hospital from 2008 to 2012, performed by a single surgeon. All the specimens were examined at the Pathology Department of Jordan University Hospital. Results: The average age of patients was 34.6 years and mean body mass index (BMI) was 45.1. Females represented 79.3% of all patients. Chronic gastritis was found in140 patients (93.3%), and Helicobacter pylori (H. pylori) was found in 51.3% of patients. Conclusion: In Jordan, chronic gastritis is most common in obese patients who underwent LSG. This finding supports previously published papers that focus on the importance of examining specimens postoperatively, also addressing a possible relation to the geographical area.
Keywords: Histopathology, Jordan, obesity, sleeve gastrectomy
|How to cite this article:|
Obeidat FW, Shahait AD, Shanti HA, Al-Momani HM, Abu Halaweh SA. Histopathology results of Jordanian patients after laparoscopic sleeve gastrectomy. Saudi J Obesity 2015;3:18-20
|How to cite this URL:|
Obeidat FW, Shahait AD, Shanti HA, Al-Momani HM, Abu Halaweh SA. Histopathology results of Jordanian patients after laparoscopic sleeve gastrectomy. Saudi J Obesity [serial online] 2015 [cited 2020 Jan 29];3:18-20. Available from: http://www.saudijobesity.com/text.asp?2015/3/1/18/158693
| Introduction|| |
According to World Health Organization (WHO), obesity is the most common disease of this era, with an estimated 1 billion adults being overweight and about 300 million of them being obese.  Moreover, the problem of obesity lies in its burden and effects on both social and medical systems. 
Recently, Khader et al.,  revealed in their study that the prevalence of overweight adults in northern Jordan was 31.4% (39.8% men and 26.8% women), while the prevalence of obesity was 51.7% (35% men and 60.8% women). This study showed a significant increase in prevalence of obesity compared to a similar study conducted in 1998. 
Despite developments in the medical field, the pathophysiology of obesity is still not clear, and multiple theories have been suggested. Studies have concluded that it is a multifactorial issue with both environmental and genetic components. Obesity can be divided into three types based on the genetic cause: i) Monogenic, ii) syndromic, and iii) polygenic (the most common). ,
With the emergence of this disease, multiple clinical treatments were established but with poor long-term results. However, bariatric surgery represents the best solution for weight loss and resolution of comorbidities with successful long-term results. ,, Laparoscopic sleeve gastrectomy (LSG) is the latest bariatric surgical procedure. It involves resection of approximately 80% of the stomach, resulting in restriction of meal size. 
There is no clear consensus regarding preoperative upper endoscopy as part of preoperative evaluation till date, and multiple studies published in this regard. Moreover, the American Society of Metabolic and Bariatric Surgery (ASMBS) did not recommend it in its recent guidelines. 
Few studies exist on the histopathological findings of patients who underwent LSG, with a majority of these studies conducted in the Arab world. ,, No single study has been conducted from Jordan, despite the increased tendency in performing this procedure.
This study aims to identify the patterns gastric pathology among obese patients underwent of laproscopic sleeve gastrectomy at Jordan University Hospital.
| Materials and methods|| |
All patients who underwent LSG between February, 2008 and December, 2012 were included in this study. All cases were operated at Jordan University Hospital by a single surgeon. The procedure was done by resecting 80-85% of the stomach from the greater curvature after inserting a Bougie tube of size 38 Fr. Resection was done using linear staplers followed by reinforcement of stapler line using sutures.
All specimens were sent to the Department of Pathology of Jordan University Hospital, and were stored in 10% buffered formalin. Then, regular sectioning was done followed by hematoxylin and eosin staining. Diseased areas underwent more sectioning.
| Results|| |
The data of 150 patients were collected and analyzed using SPSS statistics 20.0. Females represented the major percentage of patients (119 (79.3%) for women vs 31 (20.7%) for men). The mean age of patients undergoing the procedure was 34.6 ± 10.7 years and the mean body mass index (BMI) was 45.1 ± 6.9.
H. Pylori gastritis (51.3%) followed by chronic non-specific gastritis (48.7%) respectively.
| Discussion|| |
Bariatric surgeries carry multiple complications including vomiting, dumping syndrome, anastomosis problems (i.e., leak and stricture), infections, and hernias.  However, LSG, a widely accepted bariatric procedure, is associated with less complication.  It was initially described as a part of another procedure (biliopancreatic diversion with duodenal switch) in 1988. ,
To our knowledge, only three studies have tried to discover and address the most encountered histopathological findings in patients who underwent LSG, with no study published from Jordan. ,,
Our results on the basic characteristics of the studied patients are similar to that of another published study, with females being the most affected from obesity. 
From histopathological point of view, the most encountered findings were: Chronic nonspecific gastritis (48.7%) followed by H. pylori chronic gastritis (51.3%). This led us to a theory about a new entity of gastritis named "obesity-related gastritis".  The high incidence of H. pylori gastritis in our study indicates that preoperative upper endoscopy wasnot done routinely for all patients.
Our results are similar to Ahmed's  study that reported the incidence of chronic gastritis in 74% of all patients. Almazeedi et al.,  also reported a high incidence of chronic gastritis in 74.4% out of 656 patients who underwent LSG in Amiri Hospital, Kuwait, between 2008 and 2012.
On the other hand, Vrabie et al.,  showed in their study that only 23% of 87 Romanian patients had chronic gastritis, and most of them had parietal cell hyperplasia (63.2%).
These results conclude that histopathological findings in patients who underwent LSG could vary according to their geographical location. While chronic gastritis was more common in patients from the Arab world, it was much less in Romania that represented a sample from Europe.Al-Akwaa  reported that 67.7% of morbidly obese patients in Saudi Arabia have gastritis, most of which were H. pylori induced. Moreover, World Gastroenterology Organization reported that the overall incidence of H. pylori infection and related disease are much more prevalent in the developing countries (including Jordan) due to socioeconomic status and lack of proper hygiene. 
| References|| |
Global health risks: Mortality and burden of disease attributable to selected major risks, in Geneva: World Health Organization. 2009, Geneva: World Health Organization.
Wang Y, Beydoun MA, Liang L, Caballero B, Kumanyika SK. Will all Americans become overweight or obese? Estimating the progression and cost of the US obesity epidemic. Obesity (Silver Spring) 2008;16:2323-30.
Khader Y, Batieha A, Ajlouni H, El-Khateeb M, Ajlouni K. Obesity in Jordan: Prevalence, associated factors, comorbidities, and change in prevalence over ten years. Metab Syndr Relat Disord 2008;6:113-20.
Ajlouni K, Jaddou H, Batieha A. Obesity in Jordan. Int J Obes Relat Metab Disord 1998;22:624-8.
Vrabie CD, Cojocaru M, Waller M, Sindelaru R, Copaescu C. The main histopathological gastric lesions in obese patients who underwent sleeve gastrectomy. Dicle Med J 2010;37:97-103.
Rankinen T, Zuberi A, Chagnon YC, Weisnagel SJ, Argyropoulos G, Walts B, et al
. Bouchard, The human obesity gene map: the 2005 update. Obesity (Silver Spring) 2006;14:529-644.
Onzi TR, d′Acampora AJ, de Araujo FM, Baratieri R, Kremer G, Lyra Jr HF, et al
. Gastric histopathology in laparoscopic sleeve gastrectomy: Pre- and post-operative comparison. Obes Surg 2013;24:371-6.
Fisher BL, Schauer P. Medical and surgical options in the treatment of severe obesity. Am J Surg 2002;184:9-16S.
Buchwald H, Avidor Y, Braunwald E, Jensen MD, Pories W, Fahrbach K, et al
. Bariatric surgery: A systematic review and meta-analysis. JAMA 2004;292:1724-37.
Almazeedi S, Al-Sabah S, Al-Mulla A, Al-Murad A, Al-Mossawi A, Al-Enezi K, et al
. Gastric histopathologies in patients undergoing laparoscopic sleeve gastrectomies. Obes Surg 2013;23:314-9.
Mechanick JI, Kushner RF, Sugerman HJ, Gonzalez-Campoy JM, Collazo-Clavell ML, Spitz AF, et al
. American Association of Clinical Endocrinologists, The Obesity Society, and American Society for Metabolic and Bariatric Surgery medical guidelines for clinical practice for the perioperative nutritional, metabolic, and nonsurgical support of the bariatric surgery patient. Obesity (Silver Spring) 2009;17 Suppl 1:S1-70, v.
Ahmed A. Histopathological Spectrumof Laproscopic Sleeve Gastrectomiesin King Fahd Hospitalofthe University, Alkhobar, Saudi Arabia. Khyber Med Univ J 2012;4:39-44.
DeMaria EJ. Bariatric surgery for morbid obesity. N Engl J Med 2007;356:2176-83.
Adams TD, Gress RE, Smith SC, Halverson RC, Simper SC, Rosamond WD, et al
. Long-term mortality after gastric bypass surgery. N Engl J Med 2007;357:753-61.
Silecchia G, Boru C, Pecchia A, Rizzello M, Casella G, Leonetti F, et al
. Effectiveness of laparoscopic sleeve gastrectomy (first stage of biliopancreatic diversion with duodenal switch) on co-morbidities in super-obese high-risk patients. Obes Surg 2006;16:1138-44.
Gagner M, Matteotti R. Laparoscopic biliopancreatic diversion with duodenal switch. Surg Clin North Am 2005;85:141-9, x-xi.
Yamamoto S, Watabe K, Takehara T. Is obesity a new risk factor for gastritis? Digestion 2012;85:108-10.
Al-Akwaa AM. Prevalence of Helicobacter pylori infection in a group of morbidly obese Saudi patients undergoing bariatric surgery: A preliminary report. Saudi J Gastroenterol 2010;16:264-7.
World gastroenterology organisation global guideline: Helicobacter pylori in developing countries. J Dig Dis 2011;12:319-26.