Ghrelin blood test: This is a hormone whose rise stimulates
the desire to eat; and it is thought that bariatric bypass surgery
somehow results in lower hormone levels. However, we know now that most of the hormone production is in the human gastric fundus. Thus, procedures not reducing fundic mucosal mass don't reduce the hormone.
Adjustable gastric band: AGB...adjustable
gastric band ["lap band"] surgery apparently has no effect on the hormone levelsdoes not. There are no surgical specimens from this procedure.
Roux-en-Y: we get a jejunal segment and search for any occult H&E evidence of protein sensitive enteropathy; once in a while we find the mucosa to have a surprising frqency of deep lamina propria lymphoid nodules at the lamina muscularis [L10-1660; L10-10184].
Duodenal box procedure: we don't have specimen experience here.
Sleeve gastroplasty: otherwise a partial gastrectomy (vertical gastrectomy; greater
curve gastrectomy; parietal gastrectomy)...causes significant ghrelin reduction2 (the aim is to remove 75-85% of the stomach via a stapling &
excision procedure), as well as removing the part of the stomach most capable of re-expanding [L07-11288]. Sleeve gastrectomies can subsequently have additional bypass or restrictive
procedures. In our experience, maybe 2-4% of cases have a helicobacter gastritis which is positive for the organisms [L08-11800; L10-8132, L11-4324] (sometimes even positive with a mix of the normal curved rods with the large coccoid forms [L10-10535; L10-12849]) or a significant other type [L09-1020] of lesion such as fundic gland polyps [L10-9348 which can be sporadic, acquired in association with PPI-type antipeptic therapy, or as congenital with such as FAP] or foveolar hyperplastic polyps [L10-9348]. Rarely, one finds an eye-stopping increase in the mucosal lymphoid apparatus to the point that it is wise to IHC test for H. p. and even suggest the H. p. stool antigen test when the IHC is negative [L11-5893]. The specimens typically end up being a specimen that is about half the patient's gastric weight (and often weigh more than a typical normal, entire stomach).
Panniculectomy: Upon obtaining a successful weight reduction, the patient may be left with a pathologically pendulous, ptotic soft tissue panniculus (ptotic panniculopathy) which also can be pathologically further distorted by striae distensae of the skin; and it can further be pathological to the point that the patient recurringly suffers skin problems (waxing & waning rashes, erosions, and ulcers) and other problems related to the deformed & pathologically interferring panniculus.
- USA Today, July 2003.
- Obes. Surg. 15(7):1024-9, August 2005.
(posted 24 August
2003; latest update 3 June 2011)