Introduction: Gallstone (GS) formation is common in obese patients, particularly during rapid weight loss. This study aimed to determine the incidence of GS in patients underwent bariatric surgery (BS) and the influence of weight loss on GS formation. Methods: This was a prospective study including 148 consecutive patients underwent BS. Patients with preoperative negative abdominal ultrasound (US) for GS were followed-up for at least 12 months. Patients underwent abdominal ultrasound (US) at 3, 6, 9 and 12 months and were clinically screened for symptomatic or complicated cholelithiasis. No GS lowering prophylaxis was used. Clinical and demographic characteristics were compared at baseline and 12 months after surgery. Results: At time of surgery GS was found in 40.6% of the studied patients and history of previous laparoscopic cholecystectomy (LC) was in 6.8% of the studied patients. The incidence of post bariatric GS at 12 months was 22.7% with significant difference (P-value<0.05), (Laparoscopic Sleeve Gastrectomy (LSG): 18.8%, Single anastomosis sleeve ileal bypass (SASI): 33.3%, Mini Gastric Bypass (MGB): 40%, LRYGB 50%). BS operations, rapid weight loss and gastro esophageal reflux disease (GERD) patients are at a higher risk for GS. Conclusions: The incidence of post bariatric GS at 12 months was high (22.7%) with significant difference and we recommend routine US every 3, 6, 9 and 12 months during the first year after BS.

Background. Obesity and weight loss after bariatric surgery have a close association with gallbladder disease. The performance and proper timing of laparoscopic cholecystectomy (LC) with bariatric surgery remain a clinical question. Objective. Evaluation of the outcome of LC during bariatric surgery whether done concomitantly or delayed according to the level of intraoperative difficulty. Methods. The prospective study included patients with morbid obesity between December 2018 and December 2019 with preoperatively detected gallbladder stones. According to the level of difficulty, patients were allocated into 2 groups: group 1 included patients who underwent concomitant LC during bariatric surgery, and group 2 included patients who underwent delayed LC after 2 months. In group 1, patients were further divided into subgroups: LC either at the beginning (subgroup A) or after bariatric surgery (subgroup B). Results. Operative time in group 1 vs. 2 was 92.63 ± 28.25 vs. 68.33 ± 17.49 ( p < 0.001 ), and in subgroup A vs. B, it was 84.19 ± 19.62 vs. 130.0 ± 31.62 ( p < 0.001 ). One patient in each group (2.6% and 8.3%) had obstructive jaundice, p > 0.001 . In group 2, 33% of asymptomatic patients became symptomatic for biliary colic p > 0.001 . LC difficulty score was 2.11 ± 0.70 vs. 5.66 ± 0.98 in groups 1 and 2, respectively, p < 0.001 . LC difficulty score decreased in group 2 from 5.66 ± 0.98 to 2.26 ± 0.78 after 2 months of bariatric surgery, p < 0.001 . Conclusion. Timing for LC during bariatric surgery is challenging and should be optimized for each patient as scheduling difficult LC to be performed after 2 months may be an option.

Background/Introduction. The single anastomosis sleeve ileal (SASI) bypass is a novel metabolic/bariatric surgery operation based on minigastric bypass operation and Santoro’s operation. Objectives. The aim of this study is to present the clinical outcomes of SASI bypass as a treatment alternative for patients with morbid obesity. Methods. This study was a prospective follow-up of morbidly obese patients who underwent SASI bypass at Helwan University Hospital between March 1, 2019, and March 2020. The surgical procedure involved sleeve gastrectomy, followed by the anastomosis of the ileum, which was brought and hand-sewn 4 cm length side to side with the antrum, at a distance of 250 cm from the ileocecal valve. The data collected for the study included the resolution of comorbidities, incidence of gallstones, and one-year morbidity. Results. The mean age of the studied patients (n = 30) was 44.13 ± 8.9 years. The mean BMI of the studied patients was 47.3 ± 7.6 kg/ht2. All patients were morbidly obese for an average of 24 years. Postoperatively, 48% of the patients (n = 13) developed gallstones (GS), and the formation of GS was significantly higher in patients with longer durations of obesity ( P  = 0.009) and rapid weight loss. There was a significant decrease in the incidence of GS after 12 months postoperatively ( P  < 0.05). 63% of the patients (n = 19) had malnutrition, and 15 cases required revision due to the fear of further weight loss. Revision and malnutrition were significantly higher among male patients than female patients and among patients with longer durations of obesity ( P  ≤ 0.001). Conclusion. The SASI bypass may be an effective bariatric and metabolic surgery that can achieve satisfactory weight loss and improvement in medical comorbidities. However, our study highlights the potential risks of severe malnutrition and unpredictable weight loss; patient selection and duration of obesity may play a role in mitigating these risks.