Unmasking Hidden Risks: The Essential Role of Routine Di-Agnostic Laparoscopy in Sleeve Gastrectomy

This multicenter retrospective study investigates the utility of routine lower abdominal diagnostic laparoscopy (DL) during sleeve gastrectomy (SG) for identifying and managing incidental intra-abdominal pathologies in a high-risk obesity cohort. Data from 371 patients undergoing SG with concurrent DL across three Libyan centers (January 2021-December 2024) were analyzed. DL involved systematic abdominal exploration using a 180° camera rotation in a 45° reverse Trendelenburg position using a 300 lens. Incidental findings were detected in 6.5% (n = 24), including cysts/masses (45.8%, n = 11), adhesions (29.2%, n = 7), hernias (16.7%, n = 4), and other pathologies (8.3%, n = 2). These findings prompted and one procedure abortion, one precancerous mass excision through left side oophorectomy-pathology revealed mature teratoma-and was rescheduled for SG later. The median operative time increased by 3-7 minutes, with no morbidity or mortality related to DL. Two patients with incidental hernias required emergency repair within 90 days. Patients requiring intervention had similar hospital stays (1-2 days). Preoperative ultrasound failed to detect all laparoscopically identified pathologies. Routine DL during SG proved feasible and safe, adding minimal operative time while enabling timely interventions that potentially averted long-term morbidity. The findings underscore DL's critical role in detecting occult pathologies in obese populations, particularly where preoperative diagnostic accuracy is limited. Standardizing DL in bariatric protocols is advocated to enhance intraoperative decision-making and patient safety.