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Background: The dramatic weight loss achieved with medical or surgical therapies is associated with an increased incidence of biliary pathologies, due to high incidence of gallstones formation. In the last 35 years, this issue has been addressed differently, along with the development of mini-invasive techniques applied to bariatric patients suitable for reducing the overall surgical risk. Indeed, since a two staged approach was introduced in the current practice to treat obesity, a consensual decrease in prophylactic cholecystectomies in course of the primary bariatric procedure was reported Methods: A systematic review of the literature was performed using the most common electronic sources. A manual search of the references was also performed. The most significant results obtained were related with the different mechanisms involved in the bariatric surgeries to point out possible predictive factors for the development of gallstones; modified strategies to treat possible complication are exposed. Results: No consensus is available on how to prevent and manage asymptomatic gallstones. Specific circumstances are discussed to point out the differences with the general population. A brief summary about the possible causes, working diagnoses, and timing for treatment is also suggested upon last evidences. Conclusion: since the laparoscopy changed the old paradigm of maximizing all the possible procedures in the same laparotomy, times seem mature for a consensus on the timing to tackle biliary problems, because the widespread of bariatric surgery and the long life expectance of the ex-obese patients will increase the incidence of post-surgical gallstones.

When Small Issues Can Cause Big Problems: A Review of the Evidence- Based Prevention and Treatment of Gallstones Following Bariatric Surgery