Surgeons and Experts’ Perspectives in Concomitant Bariatric Surgery with Cholecystectomy: Bari-Chole Egypt Survey

INTRODUCTION: The management of gallbladder disease during metabolic and bariatric surgery (MBS) remains controversial. Cholelithiasis is common in patients with obesity, yet the approach to concomitant or prophylactic cholecystectomy varies, with limited data from Egypt. This study aimed to assess Egyptian bariatric surgeons' practices, attitudes, and decision-making regarding cholecystectomy during MBS. METHODS: A national cross-sectional survey was distributed to bariatric surgeons in Egypt, collecting information on demographics, surgical experience, preoperative screening, intraoperative decision-making, postoperative management, and prophylactic practices. The questionnaire included structured, closed-ended questions. Data were analyzed descriptively and compared between IFSO members and non-members using chi-square or Fisher's exact tests, with p < 0.05 considered significant. RESULTS: A total of 117 surgeons participated, predominantly male (99%), with 16.2% IFSO members. Bariatric surgery was concentrated in Cairo (42%) and Alexandria (26%). Most surgeons (97%) screened gallstones preoperatively using abdominal ultrasound. Concomitant cholecystectomy was preferred for documented gallstones by 78%, while 82% never performed prophylactic cholecystectomy in patients with normal gallbladders. The majority performed the bariatric procedure first (82%) in reverse Trendelenburg position (88%), minimizing additional ports. Routine intraoperative cholangiography was rare (1.7%). Postoperative management largely mirrored isolated bariatric surgery, although antibiotic and drain practices differed between groups. Surgeons generally perceived combined procedures as safe, with 76% reporting no increase in complications and 89% reporting similar length of stay. CONCLUSION: Egyptian bariatric surgeons consistently screen for gallstones and favor concomitant cholecystectomy for documented stones, while largely avoiding prophylactic removal of normal gallbladders. Variation exists in intraoperative management and postoperative care. These findings highlight areas for standardization and support the development of a national pathway and multicenter registry to optimize gallbladder management in MBS.

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Journal
Obesity Surgery
Published
2026-10-05
DOI
https://doi.org/10.1007/s11695-026-08907-8
Primary Topic
Bariatric Surgery and Outcomes
Type
article
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article

Surgeons and Experts’ Perspectives in Concomitant Bariatric Surgery with Cholecystectomy: Bari-Chole Egypt Survey

Hesham Abdelaziz ElmelIgy, Ibrahim Galal, Mossad Hemida, Abdel-Hafez Abdel-Aziz Selim et al.
Obesity Surgery
Bariatric Surgery and Outcomes
article

Surgeons and Experts’ Perspectives in Concomitant Bariatric Surgery with Cholecystectomy: Bari-Chole Egypt Survey

Hesham Abdelaziz ElmelIgy, Ibrahim Galal, Mossad Hemida, Abdel-Hafez Abdel-Aziz Selim, Abduh Elbanna, Abd-Elfattah Kalmoush, Hesham Abdallah, Islam El-Sayes, Mahmoud Abdelnasser Eissa, Alaa Mostafa Sewefy, Ashraf Elattar, Hamdy Khaled Sabra, Ahmed Abdelsalam, Hosam Mohamad Hamza, Ahmed Mehrez Gad, Mohamed Elmanakhly, Hamdi Elbelkasi, Alaa Badawy, Mohamed Ibrahim El Sayed Henish, Karim Sabry, Mohammed Atef, Mohamed Ahmed Tolba, Mohamed Tolba, Aliaa Selim, Mohamed Hassan Elkaseer, Mohammed Arafat Abdel-Maksoud, Mohamed M. Abdalgaliel, Khaled Gawdat, Waleed Abdelsalam Abdelatty Anber, Ahmed El Assal, Hossam Ramadan Moussa, Karim Al Amir, Ayman El-Wakeel, Ahmed Abokhozima, Ahmed Abo Elmagd, Islam Abdelkhalek, Ahmed A. Badawy, Mohamed Shaker, Mohamed Ramadan Sobh, Mohamed S. Elgendy, Hassan El-Masry, Haitham H. Mohy, Mohamed Fikry, Amr Elsayed Madyan, Mohammed Abdalmegeed Hamed, Ahmed Fadaly, Gamal Maher El Sayed Mosta Tofaha, Mahmoud ElSafty, Ahmed Aboelmagd, Ahmed M. Kandel, Mohamed Hany Ashour, Mohamed Mokhtar Arafat, Mahmoud Ashraf Hussein, Mohamed Maher Elaraby, Mohamed AbouZeid, Hosam Elghadban, Mohammed Ahmed Omar, Mohey Elbanna, Alaa Abbas, Husseiny Nabil, Ahmed Farid Ahmed, Ibrahim Shalaby, Mohamed Alaaeldin Hassan Bakeer, Ahmed Elfeky, Ahmed Shibl, Ahmed Hamza, Mahmoud Sherif, Mohammed Ammar, Mohamed Sobhy Shaaban Abd El-Kader, Mohamed AbdelSalam Newira, Mahmoud Eid Sabbak, Mohammed Khalil, Hamdy Sedky, Mohammed Mahdy Abdelsalam Sherif, Mohamed HossamElDin Hussein Rushdy Zidan, Collaborative Bari-Chole Survey Group, Mohamed Abd El Fatah Emam, Aiman Mandour Ismaeil, Eslam Habib, Ahmed Taher, Mohamed Ibrahim Abada, Ahmed Khalil, Mohamed Elemawy, Ayman M. Elwan, Ahmed Alghamery, Emad Abdullah, George Ezzat Fahmy Hanna Yacoup, Ahmed Mohammed Abdelfatah Ali, Ayman Abou Shmeila, Mina Melad Boshra Yosef, Ahmed Hosny Darwish, Khaled Katari, Mohamed Sobhy, Alaa Amer, Mohamed Shalamesh, Alaa Abdelaty Mahmoud, Mohamed Abbas Altaf, Abdelfattah Abozaid, Hany Armia Balamoun, Ahmed Hassan Mohamed Soliman
article en

Abstract

INTRODUCTION: The management of gallbladder disease during metabolic and bariatric surgery (MBS) remains controversial. Cholelithiasis is common in patients with obesity, yet the approach to concomitant or prophylactic cholecystectomy varies, with limited data from Egypt. This study aimed to assess Egyptian bariatric surgeons' practices, attitudes, and decision-making regarding cholecystectomy during MBS. METHODS: A national cross-sectional survey was distributed to bariatric surgeons in Egypt, collecting information on demographics, surgical experience, preoperative screening, intraoperative decision-making, postoperative management, and prophylactic practices. The questionnaire included structured, closed-ended questions. Data were analyzed descriptively and compared between IFSO members and non-members using chi-square or Fisher's exact tests, with p < 0.05 considered significant. RESULTS: A total of 117 surgeons participated, predominantly male (99%), with 16.2% IFSO members. Bariatric surgery was concentrated in Cairo (42%) and Alexandria (26%). Most surgeons (97%) screened gallstones preoperatively using abdominal ultrasound. Concomitant cholecystectomy was preferred for documented gallstones by 78%, while 82% never performed prophylactic cholecystectomy in patients with normal gallbladders. The majority performed the bariatric procedure first (82%) in reverse Trendelenburg position (88%), minimizing additional ports. Routine intraoperative cholangiography was rare (1.7%). Postoperative management largely mirrored isolated bariatric surgery, although antibiotic and drain practices differed between groups. Surgeons generally perceived combined procedures as safe, with 76% reporting no increase in complications and 89% reporting similar length of stay. CONCLUSION: Egyptian bariatric surgeons consistently screen for gallstones and favor concomitant cholecystectomy for documented stones, while largely avoiding prophylactic removal of normal gallbladders. Variation exists in intraoperative management and postoperative care. These findings highlight areas for standardization and support the development of a national pathway and multicenter registry to optimize gallbladder management in MBS.

Obesity Surgery
Ain Shams University (EG), Kafrelsheikh University (EG), Al-Azhar University (EG), Tanta University (EG), North Devon District Hospital (GB), Alexandria University (EG)
Science and Technology Development Fund
Good health and well-being
Openalex Percentile: Top 10%
Bariatric Surgery and Outcomes
DOIOpen Access PDFOpenAlex
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