Unanticipated findings at bariatric surgery

Abstract 

Background

Obesity is associated with an increased prevalence of various intra-abdominal malignancies. There is little consensus as to the screening of the morbidly obese for these malignancies, and there are no guidelines for screening these subjects before bariatric surgery or performing a survey examination during abdominal bariatric surgery.

Methods

A prospective analysis of 400 consecutive patients (362 women and 38 men) undergoing gastric bypass surgery was performed to identify the incidence of unanticipated intra-abdominal pathology.

Results

All patients underwent abdominal exploration via an upper midline abdominal incision before gastric bypass surgery. Of the 400 patients, abnormalities were found in 31 (8%); 25 of these abnormalities were related to the ovaries. In only three cases (one case each of carcinoid of the appendix, Sertoli-Leydig cell tumor of the ovary, and serous cystadenocarcinoma of the ovary) would there have been a significant difference in the patient’s prognosis had the problem been left undiagnosed.

Conclusion

It is reasonable to at least evaluate the ovaries in all female patients before proceeding with weight-loss surgery.

Keywords:  Bariatric surgery , Weight loss surgery , Ovarian cysts , Dermoid tumors , Ovarian cancer , Stomach gist tumor , Diverticulitis , Ovarian Sertoli-Leydig tumor , Intraoperative cancer screening