Incidental pathologic findings in open resectional gastric bypass specimens with routine cholecystectomy and appendectomy

Background: Morbid obesity has become a public health epidemic in the United States. With this epidemic, the demand for surgical intervention has led to rapid growth in the field of bariatric surgery. Although various procedures exist, one of the procedures offered at our institution is resectional Roux-en-Y gastric bypass with incidental cholecystectomy and appendectomy. This procedure allows for pathologic assessment of otherwise normal viscera routinely removed as a part of the gastric bypass. The purpose of this study was to determine the incidence of abnormal findings of the extirpated, gallbladder, appendix, and distal stomach after gastric bypass surgery. Methods: We performed a retrospective review of 427 patients undergoing Roux-en-Y at a tertiary level medical center. Results: Abnormal findings were divided according to the organ. In the gastric remnant, the reported pathologic findings included chronic or active gastritis in 66, fundic gland polyps in 7, intestinal metaplasia in 3, gastric ulcers in 2, gastropathy in 2, lymphoid aggregate in 1, diverticulum in 1, a developmental cyst in 1, and leiomyoma in 1. We analyzed 311 appendixes and found the following abnormalities: fibrous obliteration of the appendiceal lumen in 76, carcinoids in 2, infarcted appendicial epiploica in 2, follicular hyperplasia in 2, and subserosal endometriosis in 1. In the gallbladder the sole abnormality, other than cholelithiasis, was an adenomyoma. Other resected findings included five Meckel's diverticula, one bile duct adenoma, and one sigmoid diverticulum. Conclusion: The results of our study have shown that the resection of grossly normal and asymptomatic organs results in a very low prevalence of clinically significant incidental pathologic findings.