Saudi Journal of Laparoscopy

: 2016  |  Volume : 1  |  Issue : 1  |  Page : 31--36

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 Bariatric surgery outcome for the last 4 years

Abdulmenem Abualsel

King Hamad University Hospital, Al Sayh, Bahrain

King Hamad University Hospital is an academic hospital affiliated to RCSI, Bahrain recognized as the Centre of Excellence for Bariatric and Metabolic Surgery by IFSO endorsed COE Program. Bariatric surgery was started at King Hamad University hospital in September 2012 with a Single Bariatric Consultant. A total of 400 cases have been performed till September 2015. We have performed 195 cases of sleeve gastrectomy, 101 cases of One Anastomosis Gastric Bypass (OAGB), 63 cases of Bilio-pancreatic diversion, 15 cases of Gastric Bypass and 36 cases of sleeve gastrectomy with Transit bi-partition. Result BMI between (35-80) averages 50. 64% female and 36%is male. The age classification between (15-70) years in average 25 year.

Complications: 5 cases of gastric bleeding, 3 cases Gastric Leak in which one from Sleeve Gastrectomy and 2 from One Anastomosis Gastric Bypass (OAGB), One case of PE. Mortality one case, 0.25%. We performed a new procedure called (Gastric Sleeve with bi-partition) for 36 cases. These patients had excellent outcome at early stage, but as time passed it was found increase in protein mal-absorption percentage. Where 5 cases were converted to Sleeve Gastrectomy, and the Gastric Sleeve with bi- partition procedure was discontinue.

 Long-term outcome of sleeve gastrectomy surgery on weight loss and glycemic control in a Middle Eastern Military Hospital

Khalid Al Khalifa, Ahmed Al Ansari

Saudi Arabia

Background: Obesity and its associated metabolic disorders are strongly linked with both morbidity and mortality. Gastric sleeve surgery has been established as an effective means of weight loss for obese patients, as well as a treatment for type 2 diabetes. This study aims to examine the long-term outcomes of sleeve gastrectomy patients in a Middle Eastern military training teaching hospital.

Methods: Clinical outcomes of 59 patients with T2DM who underwent sleeve surgery between 2011 and 2014 with a follow up within 1 to 4 years were assessed at our institution. Data were collected and compared for pre- and post- BMI, HbA1C, and fasting blood glucose. Complete remission was defined as FBG less than 100 mg/dL and HbA1c less than 6 mg/dl and patients should be off diabetic medication.

Results: All patients improved their BMIs significantly between the time directly before their gastric sleeve procedures and the time of data collection. The patients who had their surgeries in 2014 showed the least amount of weight loss over the 1-year period post-surgery. Tighter glycemic control was achieved for both diabetic and prediabetic patients.

Conclusions: Sleeve gastrectomy is beneficial in terms of both long-term weight loss and glucose control in both diabetic and prediabetic obese patients.

 Nonalcoholic fatty liver disease resolution following sleeve gastrectomy

Ardeshir Algooneh 1 , Sulaiman Almazeedi 1 , Salman Al-Sabah 1 , Maha Ahmed 2 , Feras Othman 1

Departments of 1 Surgery and 2 Radiology, Amiri Hospital, Kuwait Ministry of Health, Kuwait City, Kuwait

Background: Non-alcoholic fatty liver disease (NAFLD), a disease highly prevalent among the morbidly obese population, is one of the most common causes of chronic liver disease today. The purpose of this study is to observe the effect of laparoscopic sleeve gastrectomy (LSG) on the resolution of NAFLD.

Methods: A retrospective study was conducted of 84 patients diagnosed with NAFLD prior to undergoing LSG. The diagnosis of NAFLD was achieved based on transabdominal ultrasonographic imaging as per the 2012 joint guidelines for the diagnosis of NAFLD (American Gastroenterological Association, American Association for the Study of Liver Diseases, and American College of Gastroenterology). The patients had follow-up anthropometric measurements and were re-evaluated with post-operative ultrasounds at different time frames to assess for the resolution of the disease.

Results: The median age of the patients was 44 (17-62) and 66.7% were female. Average time since surgery was 3.3 years (range 1-5 years). The mean pre and post-operative BMI were 46.6 ± 7.8 and 33.0 ± 7.1 respectively, with a mean percent excess weight loss (%EWL) of 55.7% ± 23.0. A total of 47 (56%) patients showed complete resolution of NAFLD post-operatively. Multivariate analysis showed a significant resolution of NAFLD in patients achieving >50% EWL (OR 10.1; p<0.001) after controlling for age and sex.

Conclusions: Weight loss after LSG effectively resolved NAFLD in more than half of the obese patients in this study and can prove to be a useful tool in tackling the disease in the future.

 Successful weight loss after sleeve gastrectomy: Sex matters

Shamlan AlBader

Ministry of Health, Kuwait City, Kuwait

Introduction: A common dispute within bariatric surgery is inconsistencies in achieving adequate weight loss. Many factors may play a role, and this paper aims to observe some of the predictors of successful excess weight loss post-sleeve Gastrectomy.

Methods: 190 women and 78 men underwent sleeve Gastrectomy, with weight measurements taken at 2 weeks, 3months, 6 months and 12 months after surgery. Two groups were created, those that achieved >50% excess weight loss (%EWL) compared to those <50% EWL one year post-op. The variables investigated were age, sex, pre-surgical BMI, and follow-up appointment attendance.

Results: The mean age of participants in this study was 33.98 (SD=12.04 years), and the majority were female (71%). The mean BMI was 47.32 kg/m 2 (SD = 9.8 kg/m 2 ). Two groups were created, those that achieved >50% EWL at 12 months [Table 1]. Pre-surgical BMI appeared to be the strongest predictor variable with an OR of 0.93 (95% CI 0.89-0.096), p<0.001. Our data showed no statistical differences (P>0.05) between mean age of females (34.5±11.8 years) and males (32.5±12.5 years). There was similar follow-up attendance between males and females 63% and 68% respectively (P>0.05).{Table 1}

 Bariatric surgery in Oman - Where we stand in 2015

Raad Al Mehdi

The Royal Hospital, Muscat, Sultanate of Oman

Introduction: With the ever rising tides of Obesity and metabolic diseases, the effect as monitored by the WHO on the population here is no different from that seen in the Gulf and globally. The prevalence of Obesity is now in excess of 38% of females and 25% of males. Diabetes stands above 17% of the population. At the Royal Hospital, Bariatric services started in 2012 and is currently the sole such service regularly offered in a major public hospital in the country.

Methods: Retrospective study from a prospective data base of all Bariatric procedures done at the Royal Hospital between 2012 and November 2015. Statistical analysis was done using SPSS 16.

Results: 150 cases of Sleeve Gastrectomy were done. Average pre-op weight of 125kg and BMI of 48 came down at 2 years follow up, to 75 kg and 30 respectively. There were no mortalities, no conversions, no anastomotic leaks, and no stenoses in this series. Deranged FBS was in 34% of the group in whom resolution of Diabetes was in 85%.

Conclusions: Sleeve Gastrectomy remains a good option in Oman due to high Gastric cancer prevalence and the ability to access the remnant stomach if needed in the future. The results till date offer an encouraging trend with positive early results in both weight loss and resolution of metabolic problems.

There is an urgency to expand and consolidate the available efforts, to face off the increasing demand on the service. This report will dwell into the challenges and possible solutions to this major task.

 Review of outcome of patients admitted for bariatric surgery at Al-Emadi Hospital - Qatar

Mohamed Al Emadi, Parvaneh Amani 1

Department of General and Bariatric Surgery, Al Emadi Hospital, Doha, Qatar

Background: Al Emadi Hospital (accredited as center of Excellence in Metabolic and Bariatric Surgery by Surgical review Corporation (SRC)) is a 70-bedded Acute Care General Hospital offering a full range of comprehensive inpatient and outpatient services since 2004. This review will summarize the outcome of bariatric patients admitted at AlEmadi Hospital, Qatar.

Methods: This is a descriptive study which reviewed the retrospectively collected data from 4457 who have patients undergone bariatric surgery procedure as experience of a single surgeon during the period of January 2008 until September 2015 at Al-Emadi Hospital, Qatar. Demographics data, post operation complications, and percent of excess weight loss were collected from the patient file, surgeon log book, and the referral complications feedback from the main public hospital. Descriptive statistics and t-test of means analysis were used to analyze the data using SPSS software version 22.

Results: A total of 4457 patients underwent bariatric surgery at Al-Emadi Hospital. The mean age was 36 years (20-58) with 92.8% of patients being Qatari residents and 68.1% (n= 1075) were females. Overall bariatric surgery performed at Al-Emadi Hospital were 90.7% (n= 4043) Laparoscopic Sleeve Gastrectomy, 5.1% (n= 224) Laparoscopic Adjustable Gastric Band Removal to Laparoscopic Sleeve Gastrectomy, 1.53% (n= 68) Laparoscopic Gastric Bypass, 1.3% (n= 58) Laparoscopic Gastric Plication, 0.65% (n= 29) Laparoscopic Gastric Re-Sleeve, 0.58% (n=26) Laparoscopic Mini-Bypass, 0.13% (n= 6) Laparoscopic Reversal of Plication to Laparoscopic sleeve Gastrectomy, and 0.07% (n= 3) Vertical band. Overall mean BMI of patients underwent to the Bariatric surgery was 43.11kg/m2. Post bariatric surgery follow up revolved that there is a significant reduction in BMI by an average of 31kg/m2. In the short-term follow up (around 11 to 13 months), there was a statistically significant drop in BMI (p < 0.05) of pre and post bariatric surgery and the mean excess weight loss was 65.1%. A total of 0.5% (n= 21) complication cases were reported as 0.26% (n= 10) leaks, 0.08% (n=3) bleeding, 0.08% (n= 3) PV Thrombosis, 0.05% (n= 2) hernias 0.05% (n= 2) hematoma, 0.03% (n= 1) stricture, 0.03% (n= 1) Pulmonary Embolism, and one case of death (0.03%).

Conclusions: Effective weight loss was observed in morbidly obese patients after undergoing bariatric surgery during short-term follow up. The overall risk of death and adverse outcome after bariatric surgery was low, varying considerably with patient characteristics. However, a long-term follow up study is required to confirm these promising results.

 Gastric perforation following intra-gastric balloon insertion: combined endoscopic and laparoscopic approach for management: Three case reports and review of literature

Bassem Abou Hussein, Ali Khammas

Rashid Hospital (Dubai Health Authority) Dubai, United Arab Emirates

Obesity is a serious disease, with substantial morbidity and mortality. The endoscopic placement of an intragastric balloon (IGB) in association with a low-calorie diet is an option for the treatment of obesity. IGB complications include dislocation of the balloon causing intestinal obstruction, upper gastro-intestinal bleeding and perforation. These complications occur mainly during balloon insertion or removal. Here, we report three cases of gastric perforation occurring several months after IGB insertion that were successfully treated by a minimally invasive combined endoscopic and laparoscopic procedure.

 Different leaks… Same management

Ali Khammas

President of Emirates Society of Metabolic and Bariatric Surgery

We report 4 cases of different leaks that were managed with irrigation drainage technique. First leak is after portal vein thrombosis and resection of 2.5 meters of small bowel the leak was in the anastomosis which was repaired and re leaked just at the DJ junction. The second leak of MGB in the pouch, which was repaired by stitch but re leaked without septic symptoms. 3 rd leak is after repair of 5 cm hiatal hernia and MGB the pouch leaked at the GE junction which was pulled up to the mediastinum. 4 th case of complicated sleeve leak managed in Egypt with laparotomy and fistulojejunstomy and was complicated with severe GE junction stenosis. Esophagojejunostomy done but leaked. All of the above managed successfully with different ideas of irrigation drainage techniques.

 More than 10 years results of sleeve gastrectomy prospective study

Sami Salem Ahmad, Suhaib Ahmad 1

Jordan Hospital Amman, Jordan, 1 Universal Hospital, Abu Dhabi, United Arab Emirates

Background: Morbid obesity (MO) is a worldwide problem, and its' incidence is increasing at an alarming rate. Surgical therapy has been shown to result in significant and sustainable weight loss. The positive effect on the co-morbidities, like diabetes mellitus type 2, hypertension, hyperlipidaemia and joint pain was observed in many studies.

Objectives : To analyze prospectively, the outcomes of sleeve gastrectomy to treat morbidly obese patients in our center during the period 2001-2015.

Method: 880 morbidly obese patients underwent Laparoscopic sleeve gastrectomy (SG) for weight reduction. The technique was performed over 36fr. tube and in 80% of the cases with oversuturing. 720 were available for follow up, 31% males, 69% females, mean age 35.2 + 12 Years, mean weight 108 Kg, mean BMI 42 kg/m 2 . We investigated body mass index (BMI) changes, intra- and postoperative complications, patient satisfaction, changes of the co-morbidity related to obesity. Follow up contact by visits, phone calls or Emails regular. Patients satisfactions were assessed using Moorhead-Ardelt Quality of life questionnaire (self-esteem and activity level) have been considered .

Result: Mortality rate was 1 patient due to lung embolus (0.11%), Bleeding by 6 patients (0,68%), two of them needed re-laparoscopy in the early peri-operative period, leakage by 6 patients (0.68%). 18 port site infections (2%). 20 lung attelactasis (2.3%), Mean excess weight loss (EWL)% at 69% at 6 months 74 % at 1 year, 80% at 2 nd years, 73% at 4 th year, 74% in 5 th year and remained around 72 % up to the 10 th year. co-morbidities (Diabetes mellitus, hypertension, Joint pain, hyperlipidaemia, shortness of breath)was present in 66% of the patients preoperatively and disappeared or improved in 81 % of them postoperatively. Quality of life score improved in the majority of patients . Postop iron deficiency anemia was diagnosed in 130 patients (14.7%).

Conclusions: Sleeve gastrectomy is an efficient procedure in the hand of the expertise to reduce overweight, decrease co-morbidity and improve quality of life. It has got low peri- and postoperative complication rate.

 Weight recidivism following laparoscopic Roux en Y gastric bypass: Prevention and management

Abdelrahman A Nimeri

Division of General and Vascular Surgery, Bariatric and Metabolic Institute, Abu Dhabi, United Arab Emirates

Introduction: Morbid Obesity is a lifelong disease. Bariatric Surgery is the only effective therapy long term for morbid obesity. Different procedures have different rates of weight recidivism. The only procedures with long term follow for ten years or more is the Roux en Y gastric bypass (RYGB).

Objectives: Examine the ways to treat patients with weight recidivism after Roux en Y gastric bypass.

Methods: Review the published literature of management strategies for patients with weight recidivism after Roux en Y gastric bypass.

Results: RYGB is the only procedure with long term weight loss outcomes. In a report published in 2013, the number of RYGB performed worldwide is decreasing. In addition, the number of sleeve gastrectomy is increasing. Weight recidivism after RYGB happens in 20-40% of patient's long term and especially in patients with super obesity.

Conclusion: Bariatric surgery should be done in a multidisciplinary team approach and a high index of suspicion is necessary to avoid missing serious complications."

 Surgical strategies that may decrease leak after laparoscopic: Sleeve gastrectomy

Abdul Rehman Alsaigh

Riyadh Care Hospital, Riyadh, Saudi Arabia

Objectives: To study the effect of bougie size which is one of the surgical strategy on leak, after laparoscopic sleeve gastrectomy (LSG) in morbid obese patients.

Background: Sleeve gastrectomy has become a popular stand-alone bariatric procedure with comparable weight loss and resolution of co morbidities to that of laparoscopic gastric bypass. The most feared complication after LSG is staple line leak. Most surgeons calibrate the sleeve with 32-Fr to 40-Fr bougies. Yet there is no consensus on what bougie size is best for LSG.

Methods: Conducted a systematic retrospective review of literature to identify surgical strategies that may decrease leak after laparoscopic sleeve gastrectomy (LSG) especially size of bougie. Our systematic review yielded 112 studies encompassing 9991 LSG patients. Review included publication until 2012 .We assessed the relationship between the size of bougie used and the incidence of leak as well as weight loss.

Results: Utilizing bougie ≥40 Fr may decrease leak without impacting %EWL up to 3 years. The use of a size 40-Fr to 49 was associated with a leak rate of 1.7%, >50F 0.9% compared with those who used smaller sizes whose leak rate was 2.5%.

Conclusion: A recommendation to use the smallest bougie possible should be avoided because the risk may out weight the benefit.

 Hafr albatin experience in bariatric surgery

Gamal S Mahfooz

Hafer Albaten, Saudi Arabia

Background: Morbid obesity has become a major health problem world-wide affecting millions of people especially in our Gulf region which necessitate intervention to control it. Surgical approach prove to the most effective and durable treatment modality for management of obesity. Bariatric surgery carries high risks (bleeding and leakage) that demand a well- equipped center to carry it safely.

Aim: The aim of this study to assess the safety of performing bariatric surgery (sleeve gastrectomy) in non-tertiary center like King Khalid General Hospital in Hafr Albatin.

Method: From December 2007 to December 2012 we performed 246 cases with collaboration of King Faisal specialist Hospital and research center. LSG performed in 220 patients two of them was re-do after band removal in the same sitting, AGB in 25 patients and RYGB in one patient.

Results: The results and follow-up data of the 220 pts after LSG was Female 130(59%),male 90(41%) the mean age was 47, mean BMI 55, operative time was 140 - +10 min, there were no conversion to open surgery, 10 pts. was diabetic (22%), 9 pts. was hypertensive(19.8%), the percentages of excess weight loss (%EWL) was 42.35%, 70% and 67% at 6 months, 1 year, 3 year post-operative respectively the average post- operative BMI was 37, 32, 33, at 6 months, 1 year and 3 year respectively there was bleeding in 2 cases (4.4%), 2 cases of gastric leak one of them was redo and both cases managed conservatively with stent after referring them to KFSH and one case of mortality after three weeks post-operative(2.2%).

Conclusion: Bariatric surgery can be performed in non-tertiary health care center with good outcome and low complication rate after proper selection of the patients and collaboration with center of excellence for bariatric surgery.


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 Comparison between short stay and regular stay bariatric operations in Tertiary Hospital

Haider Alshurafa

Prince Sultan Military Medical City, Riyadh, Saudi Arabia

Introduction: Morbid obesity is a major problem and epidemic disease in all over the world and in Saudi Arabia. The bariatric operations are the most efficient and long sustainable treatment for morbid obesity. The bariatric operations have become of the commonest operative procedures with very prolong waiting list. Short stay bariatric operation is proposed as one option to reduce the waiting time.

Objectives: To compare between the short stay and regular stay bariatric operations with immediate and early outcomes.

Materials and Methods: This is a retrospective review for all the data for the patients who have underwent bariatric operations in the period between 1 April 2015 to 31 May 2015 and operated by the same team and followed up for three months.

Results: 79 patients was operated by the surgical team with 44 patients have regular stay and 35 patients have short stay pathway. Both groups have comparative demographic data with average BMI in the short stay group and regular stay group are very similar 44 kg/m 2 and 43.6 kg/m 2 respectively. The laparoscopic sleeve gastrectomy is slightly more frequently done in short stay group comparing to regular stay group, 63% and 56.8% respectively. While the Roux-en-Y gastric bypass more frequent among short stay group (20% and 6.8%), the mini-gastric bypass is more frequent among regular stay group than short stay group (34% and 17%). There was no mortality and no major morbidity in both groups. There was no re-admission and no re-operation in both two.

Conclusions: In selected patients, the short stay bariatric patients are as safe as regular stay patients with advantage of shorter hospitalization and less cost. This conclusion is still in need for further studies.

 The effects of bariatric surgeries on non-alcoholic fatty liver disease

Almulhim A 1 , Alsabhan A 1 , Alamro S 1 , Aldoheyan T 1 , Bamehriz F 1 , Abdo A 2 , Alkhalidi H 3 , Hassanain M 1,4

Departments of 1 Surgery, 2 Internal Medicine and 3 Pathology, College of Medicine, King Saud University, Riyadh, Saudi Arabia, 4 Department of Oncology, McGill, University, Montreal, Canada

Background: NAFLD is the most common chronic liver disease and is known to be associated with obesity. Bariatric surgery has been shown to be the most effective method for weight reduction, however no conclusive data exists on the potential beneficial effects of bariatric surgery on NAFLD.

Objective: Characterize lier histology, metabolic status and liver function changes of patients undergoing bariatric surgery, prior to and after weight reduction procedures.

Methods: This is a preliminary report of an IRB-approved prospective cohort study, recruiting patients undergoing bariatric surgery. With informed consents, Biopsies were obtained at baseline (intraoperatively) and 3 months postoperatively. Clinical characteristics, biochemical profile and histopathological data (steatosis, NAFLD activity score, hepatocyte ballooning, lobular inflammation and degree of fibrosis) were obtained at each time point.

Results: 23 patients were included, 7 were male and the median age was 30 years old. The average body mass index went from 46.8 kg/m 2 to 37.8 kg/m 2 at follow-up (p< 0.001). On histopathology, 9 out of 15 patients with pre-op steatosis (median score 2) had reduced steatosis scores post-op (p=0.032), fibrosis (median score 1) was also reduced in 11 patients (p=0.002) and NAS score was decreased from 4 to 2 (p=0.015). The changes in lobular inflammation and hepatocyte ballooning were not statistically significant on follow-up.

Conclusion: Preliminary results of this study describe histopathological changes following weight reduction surgery and suggest that hepatic steatosis, fibrosis and NAFLD activity score are reduced 3 months after surgery. (Registration number: NCT01619215).

Disclosure: The clinical trial is financially supported by NPST.

 Improved metabolic control following weight loss surgery: The Najran experience

Abdu Hassan Al Zobydi

King Khalid Hospital, Najran, Saudi Arabia

Background: Weight loss surgery helps to lose weight in a healthy manner and achieve optimum metabolic control in people with morbid obesity.

Objective: In this presentation, the data on patients who achieved excellent metabolic control in terms of blood glucose, serum cholesterol and triglycerides levels following weight loss surgery for morbid obesity at King Khalid Hospital, Najran is presented.

Methods: A total of 640 patients underwent weight loss surgery. Preoperatively, demographic data, symptoms, signs, physical findings, body weight, BMI, blood pressure, and all relevant investigations including blood glucose and lipid profiles among others were documented. The patients were regularly followed up postoperatively and all the physical and laboratory parameters were reassessed and recorded.

Results: Among 640 patients 410 (64%) were male and 230 (36 %) female. The mean age of patients was 31.9 years. The mean preoperative body weight was 146 Kg. and mean preoperative BMI, 49.02. 196 patients out of 640 (30%) had higher than normal fasting blood glucose levels and 72 (11.25%) were already diagnosed with diabetes. Eighteen (18) patients were on insulin with metformin and others on oral hypoglycemic agents alone. Follow up after 3 and six months showed dramatic improvement in the fasting and postprandial blood glucose levels of all 196 patients. Among the 72 patients with diabetes, the eighteen on insulin were able to discontinue insulin and maintain on metformin only. The remaining 54 patients were controlled without medication. 432 patients had higher than normal serum lipids (cholesterol, triglycerides or both). Follow up after weight loss surgery showed all of them to have lower fasting serum cholesterol and triglyceride levels. The reduction in serum triglyceride was more significant in patients with diabetes.

Conclusion: Our experience in Najran, underscores the use of weight loss surgery as an ideal method for metabolic control among morbidly obese patients. Long-term follow up is required to monitor the maintenance of normal blood glucose and lipid levels among these patients.

 Histopathologic Examination of Sleeve Gastrectomy Specimens: Necessity or Workload? A Clinicopathologic Study of 128 Cases

Fawaz AlRashid, Laila Seada

Department of Surgery and Histopathology, King Khalid Hospital, Hail, Saudi Arabia

Background: The laparoscopic Sleeve gastrectomy (LSG) has become a favored procedure in the worldwide fight against the obesity pandemic. It has an overall low rate of complications and thus gaining a worldwide popularity. Few studies have focused on histopathological findings and some claimed unnecessary and waste of time and extra workload. Others found significant findings and hidden neoplasms.

Objectives : The aim of this study is to add data about histopathologic characteristics of 128 Sleeve Gastrectomy (SG) specimens resected during the period from December 2013 to February 2015 in a single institution (King Khalid Hospital , Hail) done by a single surgeon (Dr. Fawaz al Rashid).

Methods: All patients have given a written consent to publish their data after operation. Patient's age, gender, body mass index (BMI), serum cholesterol, fasting glucose level and pathology report for any abnormal histopathologic findings were recorded.

Results : In our series of 128 cases of SG specimens, 87 (67.96 %) were women, mean age 29.1 years, while 41(32.04%) were men, with a mean age 28.6 years. Youngest patient was a female 15 years while the oldest was a male patient 48 years old. Five (3.9 %) patients were below 18 years. In 27.34 5 of cases no specific pathology could be found on histopathologic examination while 72.66 % had pathologic findings. Gastritis was the main finding being diffuse, patchy and multicentric in 30.47 %, mild and superficial in 19.53 %, follicular with lymphoid follicles in 17.96 %, and chronic active in 2.34%. Superficial erosion with few lymphocytes was found in 2.34 % of cases. No polyps or tumors were found in our series. In 51 (39.8 %) of patients, high fasting blood sugar was detected, while in 20 (15.6%) patients cholesterol was elevated, mildly , (5-6) in 12 patients, moderately (6-7) in 6 patients and markedly elevated (more than 7) in 2 patients. Six patients had a preoperative endoscopy with chronic gastritis, H.pylori-associated in 5 cases and one non-H.pylori- associated chronic gastritis. In one case, a concomitant laparoscopic cholecystectomy was also performed with a diagnosis of chronic calcular cholecystitis.

Conclusion: In the present study which is, to the best of our knowledge, the first in KSA to study histopathologic findings in SG specimens, we could find 72.66 % pathologic changes in our specimens. This percentage was too high compared with the studies done by English groups who found between 33.3 % and 45% changes, but is compared with Al Majeedi et al., 2013 from Kuwait and Gundogan et al., 2013 from Turkey who found 74.4% and 87.9%, respectively, pathologic changes. In our experience, routine histopathologic examination of SG specimens is a valuable procedure due to high percentage of unexpected findings in resected specimens.