Clinicopathologic Correlation of Initial and Revisional Sleeve Gastrectomy Procedures

The purpose of this study was to correlate histological changes of initial and revisional sleeve gastrectomies with clinical findings. We performed a retrospective analysis of all 15 patients who underwent initial and revisional gastric sleeve resections in the last 7 years at our institution. Mucosal, submucosal, and muscularis propria thickness are correlated to weight, body mass index (BMI), changes in BMI, and resolution of disease states, including hypertension (HTN), hypercholesterolemia (HCL), diabetes (DM), and obstructive sleep apnea (OSA). The average ages of the eight female and seven male patients were 39 years at initial gastrectomy and 43 years at revision. The average BMI at initial resection was 44.3 and at revision was 39.4. No cases had significant inflammation or unsuspected pathologic findings. The mucosa showed changes in the parietal (average change: –0.1 mm, P = .03) and chief cell layers (average change: 0.12 mm, P = .03). Correlated to a change in BMI is a decrease in gastric pit thickness (correlation: -0.64, P = .01) and submucosal thickness (average change: -1.3 mm, P< 0.01, correlation:0.56, P = .03). Postgastrectomy, the circular and oblique layers of the musculari propria increased by 0.3 mm each (P = .02, P < .01, respectively), and the overall musculature increased by 0.7 mm (P < .01). Within the revision cases, the submucosal thickness correlated with both the weight (0.55, P = .04) and BMI (0.62, P = .02), and the circular muscular layer correlated to BMI (0.55, P = .05). There were no significant associations observed with resolution of HTN, DM, OSA, and HCL. The oblique layer thickness of the muscular wall was decreased in patients with a higher BMI, while the parietal and chief cell layers were redistributed without an increase in mucosal thickness. Once patients underwent a revisional sleeve gastrectomy, the oblique and circular muscular layers thickened. The alterations in submucosal thickness were associated with change in BMI.