Unforeseen pathological and anatomical findings during primary metabolic and bariatric surgery - a retrospective cohort study and review of the literature

Sep 29, 2026

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Morbid obesity has become a widespread pandemic, increasing the volume of metabolic bariatric surgery (MBS) while exposing a subset of patients to unexpected pathological or anatomical findings that complicate intraoperative decision-making. A retrospective review of a prospectively maintained database identified 46 of 2387 primary MBS cases (1.9%) from June 2010 to April 2024 with previously undiagnosed findings. Incidence estimates and outcomes are presented, alongside literature-based management strategies.

LanguageEnglish

CategoryHealthcare

FormatPDF

Pages9

Reading Time23 min

AccessFree to download

Introduction

Patients and methods

Results

Conclusion

Vasas et al. BMC Surgery (2026) 26:6 [https://doi.org/10.1186/s12893-025-03387-6](https://doi.org/10.1186/s12893-025-03387-6) BMC Surgery RESEARCH Open Access Unforeseen pathological and anatomical findings during primary metabolic and bariatric surgery – a retrospective cohort study and review of the literature Peter Vasas 1,2*, Alaa Attila 1, Hussain Abdulzahra 1,3, Sashi Yel uri 1, Samuel Nehemiah 1 and Srinivasan Balchandra 1 Abstract Introduction The prevalence of morbid obesity has surpassed our previous projections and has become a real pandemic. An increasing number of patients are undergoing metabolic bariatric surgery (MBS), and a small but significant proportion of them present with unexpected pathological or anatomical findings that pose intraoperative challenges for bariatric surgeons. Patients and methods A retrospective analysis of our prospectively maintained database revealed that 46 of the 2387 patients (1 . 9%) who underwent primary MBS between June 2010 and April 2024 presented with previously undiagnosed pathological or anatomical findings during their operation. The patients’ characteristics and surgical outcomes were reviewed, and extensive literature research was conducted to establish the incidence of these findings. Results The incidence of gastrointestinal stromal tumors (GISTs) was 0 . 54%, with > 60% of cases presenting on the gastric fundus. R0 resection was considered in all patients. Seven patients (0 . 3%) had liver cirrhosis, which was confirmed intraoperatively through surgical biopsy. Large hiatal hernias incidence was 0. 8% and all required crural approximation. The incidence of benign lesions was 0 . 2%, and incidental primary or disseminated malignancies accounted for only 0. 1% of the cases. Conclusion Bariatric surgeons should be cognizant of potential intraoperative pathological or anatomical abnormalities, and this paper provides systematic and plausible strategies for managing these challenging situations. Keywords Bariatric surgery, GIST, Liver cirrhosis, Hiatus hernia, Incidental lesion *Correspondence: Peter Vasas [peter.vasas@nhs.net](peter.vasas@nhs.net) 1Doncaster & Bassetlaw Teaching Hospitals NHS Trust, Doncaster, UK 2Semmelweis University, Budapest, Hungary 3University of Alkafeel, Najaf, Iraq © The Author(s) 2025. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit [http://creati](http://creati)[vecommons.org/l](vecommons.org/l)icenses/by-nc-nd/4.0/. Vasas et al. BMC Surgery (2026) 26:6 Page 2 of 9 Introduction The prevalence of morbid obesity exceeds all our previous expectations and has become a real pandemic worldwide. Despite recent advancements in medically available appetite suppressants and various minimally invasive procedures, metabolic and bariatric surgery (MBS) remains the only sustainable and definitive solution for people with morbid obesity. Bariatric surgeons are currently experiencing a substantial surge in potential patients, and consequently, well-established, globally accepted preoperative protocols-endorsed by IF

FAQs

What was the purpose of this study?

To document incidental, unexpected pathologies and unforeseen anatomical abnormalities encountered during primary MBS and to recommend safe, scientifically rational exit strategies for surgeons.

How many patients had previously undiagnosed findings during primary MBS?

46 of 2387 patients (1.9%) underwent primary MBS between June 2010 and April 2024 with unexpected pathological or anatomical findings during their operations.

What conditions were most frequently identified among the unexpected findings?

Gastrointestinal stromal tumors (GISTs) occurred in 0.54% of cases, with more than 60% located on the gastric fundus.

Sep 29, 2026

Uploaded by Bulrr