Obesity, defined as the accumulation of body fat, has become a serious public health problem. Despite efforts to prevent it, its prevalence has increased progressively,¹ which also leads to an increase in comorbidities such as arterial hypertension, cardiovascular diseases, dyslipidemia, diabetes mellitus, steatosis and malignancies of the digestive system;² It is also associated with hiatal hernia, gastroesophageal reflux and Barrett's esophagus,³ significantly reducing the life expectancy of these people. Non-surgical methods of treatment include lifestyle changes, the adoption of low calorie diets, physical activity and the use of medication; these measures are ineffective in most cases, both in terms of effective weight loss and in maintaining weight loss once it has been achieved. Bariatric surgery has proven to be the most effective method for the treatment of morbid obesity (MO), especially for sustained weight loss and the reduction of related comorbidities.⁴ In recent years, laparoscopic vertical gastrectomy (LVG) has become the fastest growing bariatric surgical procedure in the world, due to its excellent results and less complexity in its execution, due to the absence of anastomoses.⁵ The technique removes 70 to 80 percent of the stomach through a section made in the great curvature of the stomach, from near the pylorus to 2 to 3 cm from the angle of Hiss, forming a gastric tube of around 150 to 200 ml.⁶ There are currently questions about the importance of evaluating specimens resected after GVL, and this is a point of divergence among bariatric surgeons. The literature is conflicting on the subject, while some studies show the absence of pathological abnormalities in the vast majority of cases, others have identified a series of abnormalities, including malignant lesions.^7–9 Due to the above, there is still no consensus on routine histopathological research in the postoperative period of GVL; in our country, we have no publications on the subject, justifying the relevance of this study. The main objective is to identify microscopic alterations in segments resected after GVL. Secondly, the results will be correlated with the possible presence of H pylori in the resected specimen, and possible epidemiological influences: gender, age group, body mass index (BMI).

This is a retrospective longitudinal observational study involving 104 patients who underwent LGE between July 2017 and January 2023 at the Unimed Primavera and São Paulo hospitals, located in Teresina-Pi. Preoperative upper digestive endoscopy (UDE) was systematically performed on all patients, and those who had a positive urease test for H. Pylori were treated for 14 days with a triple regimen containing esomeprazole 80 mg/day, clarithromycin 1g/day and amoxicillin 2g/day. No control test was carried out to verify eradication. The surgery was always carried out by the same team, using the standardized technique described below: A 5 mm puncture next to the xiphoid appendix to pass the forceps through to expose the liver, 2 more 5 mm punctures in the left axillary line for the assistant doctor to expose the liver, 2 12 mm punctures in the right and left flanks for the surgeon to work on. The procedure began with the dissection of the great curvature vessels, about 4 cm from the pylorus, using a harmonic scalpel (ethicon®), and continued up to 2 cm from the angle of Hiss. The gastric tube was made with 5 to 7 loads of the same company's specific stapler and shaped using a Fouchet probe 32. For better hemostasis and stabilization, the tube was always fixed to the great omentum and gastrocolic ligament. The surgical specimen was removed through the 12mm trocar, to the surgeon's right. The surgical specimens were always sent to the same pathology department in 10% buffered formalin. Macroscopic examination was carried out with random representation of different areas. After histological processing, the fragments were embedded in paraffin, cut into 4-micrometer sections and initially stained with hematoxylin-eosin (HE). Microscopic analysis was carried out and the parameters evaluated were: Findings of chronicity, inflammatory activity, glandular atrophy, intestinal metaplasia, dysplasia, and the presence of H. pylori infection. In cases with histological findings suggesting H. pylori infection (superficial lymphoplasmocytosis, lymphoid accumulations and glandular neutrophilic aggression) and the bacterium not being initially identified by HE staining, a new analysis by Giemsa staining was carried out. For statistical analysis, Fischer's exact test was applied for categorical variables; Student's t-test and Mann-Whitney U-test were applied for quantitative and independent variables respectively. The study was submitted to the Brazil platform and will be assessed by the ethics committee of the Federal University of Piauí. All participating patients signed an informed consent form (ICF), the General Data Protection Law (GDPR) was respected and the data use commitment form (DCU) was signed by the pathologist responsible.

Of the 104 patients involved in the study, 87 were female (83.63%) and 17 were male (16.35%). The average age of the patients was 36.1 ± 8.75 for women and 37.1 ± 8.25 for men (ranging from 20 to 63); the average BMI was 38.2 ± 5.5 and 41.6 ± 3.8 respectively. The characteristics of the sample are shown in Table 1. H pylori infection was found in 8 patients (7.69 %), in the other 96 (92.31 %), the bacterium was not identified, as described in the methodology all the patients had previously received a triple eradication regimen. The only histopathological alterations identified were: chronic inactive gastritis (CIG) in 10 (9.61 %), intestinal metaplasia (IM) in 1 (0.96 %), the description of an inflammatory infiltrate in the chorion in 31 (29.80 %); in the remaining 62 (59.61 %) no alterations were described (Table 2). In H pylori positive patients, chronic gastritis was found in 7 (87.50%), and also in the only case of intestinal metaplasia identified, with a positive statistical correlation; no positive cases were found in any of the 31 cases of inflammatory infiltrate in the chorion. These results are shown in Table 3. No statistical correlation was found between age, BMI and histopathological findings (Table 5); there was also no correlation with gender (Table 4).

In our study, we evaluated 104 patients who underwent VG. Similarly to other studies, the vast majority were female (87%), which in almost all centers represents the gender that most seeks surgical treatment for obesity. Absence of histopathological alterations was the most common finding (59.61%), followed by a discreet inflammatory infiltrate in the chorion (29.80%), ICG (9.61%) and 1 case of IM. Other authors have had similar results to ours, with some even questioning the importance of routine histological assessment;^10–12 AbdullGaffar et al.¹³ in 546 specimens evaluated, found alterations in less than 1% of cases, recommending examination only in selected cases, depending on the clinical history and macroscopic evaluation, which would imply less cost and loss of time; However, this is strongly questioned, with other studies reporting frequent alterations in the postoperative analysis and the possible presence of unexpected findings, such as neoplasms,^10–12 which also reinforces the mandatory need for preoperative AGE, which is systematically carried out in our group; this recommendation is also followed by Di Palma et al.¹¹ H pylori was identified in 8 cases (7.69 %) of the specimens in our study, in contrast to other authors^14,15 who found higher rates of infection; this can be explained by the fact that we carried out its investigation in the EDA and attempted to eradicate it when found.

Its identification had a positive correlation with GCI and IM findings (p<0.05), as shown in Table 5. This finding is similar to others reported in the literature;^12,14,15 Onner and Osdas, identified H pylori in 64 % of the cases of chronic active gastritis and in 8 of the IM of their specimens studied,¹⁴ but unlike our study, no preoperative eradication attempt was made, and the authors themselves report a high infection rate in their region (south-east Turkey); Nowak K et al.¹² in a review study on the subject, identified the microorganism in 14% (of 13,173 specimens evaluated) of cases of non-neoplastic findings. Although it was identified in 7 of the 31 patients (6.73 %) in whom inflammatory infiltrate was described in the chorion, there was no positive correlation with its presence; this alteration is often found in patients with previous gastritis, including H. pylori-related gastritis.^16,17 Regarding the influence of gender, no correlation was found (p= 0.1289), the vast majority, as already mentioned, were female (83.65 %); we also found no positive correlation with age groups. Saffan et al.¹⁸ in a study with a much larger number than ours (1555), found a relationship between these 2 variables and histological findings in the specimens evaluated, identifying a higher prevalence of GIST and IM in females and in older patients. In our study, both the population (N) and the age range were smaller, with the vast majority being under 60 years old, with a mean age of 36.1 ± 8.75 for women and 37.1 ± 8.25 for men; in addition, only 1 case of IM was found, so there can be no statistical correlation. Regarding the influence of BMI on histological findings, Adasi et al.,¹⁹ in a study of 37 patients, found the presence of IM in 8, with a positive correlation in lower BMI indices, which the author justifies by a possible greater production of leptin and a protective effect on the epithelium in patients with a higher body index; the same author did not find a correlation with other variables such as chronic active or inactive gastritis. In our study, BMI had no influence on the changes found; however, our range was smaller, with more than half below 40 kg/m² and, as already discussed, only 1 case of IM, so statistical analysis was not possible.

None.

The authors declare that there are no conflicts of interest.

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