Concomitant Cholecystectomy During Bariatric Surgery: Surgical Technique and Safety

Patients undergoing bariatric surgery have a substantially elevated risk of gallstone disease, both at baseline and as a consequence of rapid postoperative weight loss. The optimal management of biliary pathology identified at the time of bariatric surgery remains unsettled. We aimed to describe the clinical, radiological, surgical, and histopathological characteristics, and the short-term safety, of simultaneous laparoscopic cholecystectomy performed during bariatric surgery in patients with documented preoperative biliary pathology.

A single-center retrospective cohort of patients who underwent bariatric surgery in 2024 was analyzed. Of 692 bariatric procedures performed by a single surgical team, 117 patients with preoperative ultrasonography-confirmed gallstones or gallbladder polyps who underwent simultaneous laparoscopic cholecystectomy were included. Demographic, anthropometric, comorbidity, imaging, intraoperative, histopathological, and 30-day complication data were extracted from medical records. Only descriptive statistics were used; no concurrent control group was available, and no inferential testing was performed.

The cohort comprised 109 women (93.2%) with a mean age of 42.1 ± 10.5 years and a mean body mass index of 42.3 ± 6.4 kg/m². Hypertension (15.4%), asthma (10.3%), and diabetes mellitus (8.5%) were the most frequent comorbidities. Preoperative imaging revealed multiple gallstones in 63.2%, a single stone in 30.8%, and an isolated gallbladder polyp in 6.0%; the largest stone measured a median of 14 mm (range 3-43). Hepatic steatosis was present in 94.0% of patients and hepatomegaly in 42.7%. Sleeve gastrectomy was performed in 108 patients (92.3%) and gastric bypass in 9 (7.7%); concomitant hiatal hernia repair was carried out in 41 patients (35.0%) and revisional bariatric surgery in 8 (6.8%). Cholecystectomy was performed through the existing 5-mm epigastric liver-retractor port in every patient, with no additional trocar required and no conversion to open surgery. Histopathology demonstrated chronic cholecystitis in all specimens, with an associated cholesterol polyp in 62.4%. A single patient (0.9%) developed early postoperative bleeding that resolved with conservative management and transfusion; no surgical re-exploration was required, and 30-day mortality was zero.

Simultaneous laparoscopic cholecystectomy can be incorporated into bariatric surgery in patients with imaging-confirmed biliary pathology with a low short-term complication rate and without the need for an additional trocar in this single-team series. Prospective, multicenter, randomized studies remain necessary to define the optimal management of asymptomatic gallstone disease at the time of bariatric surgery.