Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy
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Preoperative Helicobacter pylori Screening and Treatment in Patients Undergoing Laparoscopic Sleeve Gastrectomy Adam Di Palma 1 & Sultan Alhabdan 1 & Azusa Maeda 1 & Runjan Chetty 2,3 & Stefano Serra 2,3 & Fayez Quereshy 1,4 & Timothy Jackson 1,4 & Allan Okrainec 1,4
# Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The role of preoperative screening and treatment of Helicobacter pylori (HP) in asymptomatic patients undergoing laparoscopic sleeve gastrectomy (LSG) remains unclear. This study aims to define the preoperative prevalence and management of HP and their effect on postoperative outcomes at our institution. Materials and Methods We reviewed the medical records and surgical specimens of all LSG performed at an academic centre in Toronto, ON between 2010 and 2017. Results Review of our institutional database identified 222 patients that underwent LSG, of which 200 had preoperative HP screening: 18% tested positive and 15% were treated. Seven surgical specimens were HP-positive (3.2%). No association was found between preoperative HP status, treatment or HP-positive specimen and postoperative complications at 1 year. Conclusion Although preoperative screening and treatment likely reduce the prevalence of HP in LSG specimens, our findings suggest that they may be of limited clinical value in LSG as they have little influence on surgical morbidity. Keywords Bariatric surgery . Sleeve gastrectomy . Helicobacter pylori . Preoperative screening . Surgical outcomes
Introduction The preoperative work-up for morbidly obese patients undergoing bariatric surgery is extensive and often includes bloodwork, endoscopy, imaging, medical and psychosocial assessments. The goal of this process is to select the patients that will benefit the most from bariatric surgery and to optimize patients’ comorbidities in order to improve their postoperative outcomes. Although the American Society of Metabolic and Bariatric Surgeons (ASMBS) published guidelines on the perioperative management of bariatric patients in 2013 [1], little
* Allan Okrainec [email protected]
standardization exists between preoperative evaluation protocols at different institutions performing bariatric surgery. One controversial aspect of the preoperative assessment is the role of Helicobacter pylori (H. pylori, HP) screening. Identified as a potential risk factor for marginal ulcers following laparoscopic Roux-en-Y gastric bypass (LRYGB), many studies recommend screening for HP prior to scheduling bariatric surgery [2, 3]. However, the role of HP screening is less clear in patients undergoing laparoscopic sleeve gastrectomy (LSG), as these patients do not develop marginal ulcers [4, 5]. The goal of this study is to explore the current practice and role of HP screening and treatment in patients undergoing LSG at our institution. To address this, we examined the rates of postoperative complications with respect to the presence of HP, as well as HP screening and treatment in this population.
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