1. Introduction

Currently, gallstone disease (GSD) affects more than 10% of the global population and ranks third in the overall disease structure after cardiovascular diseases and diabetes mellitus [1,11,12,26]. Every year, more than 2.5 million such interventions are performed worldwide [6].

Since the mid-20th century, the number of GSD patients has doubled every 10 years [11,21]. GSD is the cause of hospitalization in surgical departments for 30% of patients. Among patients hospitalized with acute abdominal diseases, GSD ranks second (24.4%) after acute appendicitis (26.4%) [14].

A particularly important group includes patients in whom inflammatory diseases of the gallbladder (GB) develop against the background of obesity. The global population affected by obesity has increased more than threefold [30]. According to forecasts, by 2030, 60% of the world’s population may have overweight or obesity if current trends continue [25,40]. Moreover, the problem of obesity is considered poorly studied and is not fully recognized as a state-level issue with significant economic consequences [7,39].

One of the effective methods for preventing gallstone disease (GSD) in patients who have undergone bariatric surgery is the use of ursodeoxycholic acid (UDCA). This drug affects the lithogenicity of bile, promotes its stabilization, and prevents the formation of cholesterol stones [9].

The mechanism of action of UDCA involves reducing the cholesterol saturation of bile, increasing the secretion of bile acids, and improving gallbladder motility. The drug also stabilizes hepatocyte cell membranes and exerts immunomodulatory effects [33].

It has been established that UDCA decreases bile lithogenicity, prevents the formation of cholesterol–bilirubin stones, and normalizes gallbladder motility under conditions of metabolic disturbances [3,16].

According to several authors, a short-term course of UDCA (3–6 months) after gastric surgery can reduce the incidence of postoperative cholelithiasis to 2–8%, compared to 15–30% without prophylaxis [29,32]. However, most studies are limited by conventional time frames and do not take into account the individual rate of weight loss or the severity of concomitant metabolic disorders.

The prophylactic use of UDCA is particularly significant in patients with obesity combined with type 2 diabetes, where the risk of stone formation increases 2–3 times [34]. Some authors emphasize the need for a personalized approach and extending the UDCA course until body weight stabilizes and metabolic processes normalize [38]; however, in clinical practice, this approach has been implemented only partially and requires further justification.

According to the results of five randomized clinical trials (RCTs) including a total of 616 patients, ursodeoxycholic acid (UDCA) administered postoperatively in patients without gallstones at the time of surgery significantly reduced the incidence of postoperative stone formation [36]. Although the optimal dose remains controversial, studies indicate that 500–600 mg may be sufficient [27], and the European Association for the Study of the Liver recommends prophylactic administration of at least 500 mg of UDCA before bedtime until weight stabilization [22].

Approximately 8–15% of patients who have undergone bariatric surgery develop symptomatic gallstone disease within 24 months postoperatively. In the UPGRADE study (n=985), the efficacy of 900 mg UDCA administered for 6 months was evaluated against placebo for the prevention of symptomatic gallstone disease after bariatric surgery. In patients without gallstones prior to Roux-en-Y gastric bypass, UDCA therapy reduced the incidence of symptomatic gallstone disease compared to placebo. The subgroup of patients who underwent sleeve gastrectomy was too small to draw definitive conclusions. No serious adverse events related to the study drug were reported. Adverse events were rare and did not differ between the UDCA and placebo groups [24].

Numerous randomized studies have confirmed the effectiveness of UDCA in preventing stone formation in patients after weight-loss surgery. For example, in the study by Sugerman H.J. et al. (1995), administration of UDCA at a dose of 600 mg/day for 6 months after gastric bypass reduced the risk of gallstone formation to 2%, compared to 32% in the placebo group [37]. Although the optimal dose remains controversial, studies indicate that 500–600 mg may be sufficient [27], and the European Association for the Study of the Liver recommends prophylactic administration of at least 500 mg of UDCA before bedtime until weight stabilization [22].

Approximately 8–15% of patients who have undergone bariatric surgery develop symptomatic gallstone disease within 24 months postoperatively. In the UPGRADE study (n=985), the efficacy of 900 mg UDCA administered for 6 months was evaluated against placebo for the prevention of symptomatic gallstone disease after bariatric surgery. In patients without gallstones prior to Roux-en-Y gastric bypass, UDCA therapy reduced the incidence of symptomatic gallstone disease compared to placebo. The subgroup of patients who underwent sleeve gastrectomy was too small to draw definitive conclusions. No serious adverse events related to the study drug were reported. Adverse events were rare and did not differ between the UDCA and placebo groups [24].

Numerous randomized studies have confirmed the effectiveness of UDCA in preventing stone formation in patients after weight-loss surgery. For example, in the study by Sugerman H.J. et al. (1995), administration of UDCA at a dose of 600 mg/day for 6 months after gastric bypass reduced the risk of gallstone formation to 2%, compared to 32% in the placebo group [37].

In the study by Ulumbekova A.A. and Ismailova Zh.T. (2022), it was confirmed that the use of UDCA after sleeve gastrectomy (SG) effectively prevents gallstone formation in patients with rapid weight loss. Improvement in overall liver condition was also noted based on ultrasound findings and biochemical parameters [29].

Recommendations from international organizations, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), allow the use of UDCA in high-risk patients during the first 6 months after surgery [28].

The UDCA dosage ranges from 10 to 15 mg/kg of body weight per day. Most commonly, the drug is prescribed at a daily dose of 500–600 mg, either as a single evening dose or in two divided doses. The duration of the course is 3 to 6 months. In the presence of high-risk factors, it is recommended to extend the administration up to 9 months [2]. In addition to UDCA, there are isolated reports on the use of cinnarizine and plant-based preparations; however, their effectiveness is significantly lower [19].

Although the optimal dose remains controversial, studies indicate that 500–600 mg may be sufficient [27], and the European Association for the Study of the Liver recommends prophylactic administration of at least 500 mg of UDCA before bedtime until weight stabilization [22].

Approximately 8–15% of patients who have undergone bariatric surgery develop symptomatic gallstone disease within 24 months postoperatively. In the UPGRADE study (n=985), the efficacy of 900 mg UDCA administered for 6 months was evaluated against placebo for the prevention of symptomatic gallstone disease after bariatric surgery. In patients without gallstones prior to Roux-en-Y gastric bypass, UDCA therapy reduced the incidence of symptomatic gallstone disease compared to placebo. The subgroup of patients who underwent sleeve gastrectomy was too small to draw definitive conclusions. No serious adverse events related to the study drug were reported. Adverse events were rare and did not differ between the UDCA and placebo groups [24].

Numerous randomized studies have confirmed the effectiveness of UDCA in preventing stone formation in patients after weight-loss surgery. For example, in the study by Sugerman H.J. et al. (1995), administration of UDCA at a dose of 600 mg/day for 6 months after gastric bypass reduced the risk of gallstone formation to 2%, compared to 32% in the placebo group [37].

In the study by Ulumbekova A.A. and Ismailova Zh.T. (2022), it was confirmed that the use of UDCA after sleeve gastrectomy (SG) effectively prevents gallstone formation in patients with rapid weight loss. Improvement in overall liver condition was also noted based on ultrasound findings and biochemical parameters [29].

Recommendations from international organizations, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), allow the use of UDCA in high-risk patients during the first 6 months after surgery [28].

The UDCA dosage ranges from 10 to 15 mg/kg of body weight per day. Most commonly, the drug is prescribed at a daily dose of 500–600 mg, either as a single evening dose or in two divided doses. The duration of the course is 3 to 6 months. In the presence of high-risk factors, it is recommended to extend the administration up to 9 months [2]. In addition to UDCA, there are isolated reports on the use of cinnarizine and plant-based preparations; however, their effectiveness is significantly lower [19].

A retrospective analysis of data from 600 patients who underwent bariatric procedures at the “Soglom Avlod” and “SEHAT” clinics in Andijan from 2022 to 2025 showed that among those receiving UDCA, the incidence of gallstone disease (GSD) was less than 5%, whereas in the group without pharmacological prophylaxis, this figure reached 18%.

The inclusion of UDCA in the comprehensive management program for patients after bariatric surgery appears to be a justified and pathogenetically sound approach. At the same time, it is necessary to individualize the dosing regimen and duration of administration based on the patient’s initial condition, presence of risk factors, and type of surgical intervention.

GSD remains a significant concern after bariatric procedures, especially following gastric bypass and biliopancreatic diversion. One of the surgical approaches for GSD prevention is simultaneous cholecystectomy when gallstones are detected before or during bariatric surgery [15].

Although the optimal dose remains controversial, studies indicate that 500–600 mg may be sufficient [27], and the European Association for the Study of the Liver recommends prophylactic administration of at least 500 mg of UDCA before bedtime until weight stabilization [22].

Approximately 8–15% of patients who have undergone bariatric surgery develop symptomatic gallstone disease within 24 months postoperatively. In the UPGRADE study (n=985), the efficacy of 900 mg UDCA administered for 6 months was evaluated against placebo for the prevention of symptomatic gallstone disease after bariatric surgery. In patients without gallstones prior to Roux-en-Y gastric bypass, UDCA therapy reduced the incidence of symptomatic gallstone disease compared to placebo. The subgroup of patients who underwent sleeve gastrectomy was too small to draw definitive conclusions. No serious adverse events related to the study drug were reported. Adverse events were rare and did not differ between the UDCA and placebo groups [24].

Numerous randomized studies have confirmed the effectiveness of UDCA in preventing stone formation in patients after weight-loss surgery. For example, in the study by Sugerman H.J. et al. (1995), administration of UDCA at a dose of 600 mg/day for 6 months after gastric bypass reduced the risk of gallstone formation to 2%, compared to 32% in the placebo group [37].

In the study by Ulumbekova A.A. and Ismailova Zh.T. (2022), it was confirmed that the use of UDCA after sleeve gastrectomy (SG) effectively prevents gallstone formation in patients with rapid weight loss. Improvement in overall liver condition was also noted based on ultrasound findings and biochemical parameters [29].

Recommendations from international organizations, such as the American Society for Metabolic and Bariatric Surgery (ASMBS), allow the use of UDCA in high-risk patients during the first 6 months after surgery [28].

The UDCA dosage ranges from 10 to 15 mg/kg of body weight per day. Most commonly, the drug is prescribed at a daily dose of 500–600 mg, either as a single evening dose or in two divided doses. The duration of the course is 3 to 6 months. In the presence of high-risk factors, it is recommended to extend the administration up to 9 months [2]. In addition to UDCA, there are isolated reports on the use of cinnarizine and plant-based preparations; however, their effectiveness is significantly lower [19].

A retrospective analysis of data from 600 patients who underwent bariatric procedures at the “Soglom Avlod” and “SEHAT” clinics in Andijan from 2022 to 2025 showed that among those receiving UDCA, the incidence of gallstone disease (GSD) was less than 5%, whereas in the group without pharmacological prophylaxis, this figure reached 18%.

The inclusion of UDCA in the comprehensive management program for patients after bariatric surgery appears to be a justified and pathogenetically sound approach. At the same time, it is necessary to individualize the dosing regimen and duration of administration based on the patient’s initial condition, presence of risk factors, and type of surgical intervention.

GSD remains a significant concern after bariatric procedures, especially following gastric bypass and biliopancreatic diversion. One of the surgical approaches for GSD prevention is simultaneous cholecystectomy when gallstones are detected before or during bariatric surgery [15].

According to several researchers, the presence of even asymptomatic gallstones is an indication for prophylactic cholecystectomy at the time of bariatric surgery, especially in patients at high risk of developing complications [5,35].

However, there are opposing views. Some authors point out the increased risks of simultaneous cholecystectomy, including prolonged operative time, higher risk of intraoperative complications, and impaired reparative processes [8]. Therefore, in some clinics, a selective approach is applied: cholecystectomy is performed only in the presence of symptomatic gallstone disease or pronounced biliary pathology.

It is not uncommon, especially in individuals with excess weight, for the physical and chemical properties of bile to change, leading to the formation of gallstones within the gallbladder. When the gallbladder contracts, these stones can obstruct its outlet, resulting in acute inflammation of the gallbladder (acute cholecystitis) or, even worse, the stones may migrate into the common bile duct, leading to jaundice and the risk of developing pancreatitis (acute pancreatitis). Cholelithiasis (in most cases) is itself an indication for surgery – the removal of the gallbladder. If gallstones are detected in the gallbladder during preoperative evaluation before bariatric surgery, this is a reason to perform a simultaneous cholecystectomy along with the bariatric procedure to prevent complications associated with gallstone disease.

If there are no stones in the gallbladder, removal of a healthy gallbladder is not necessary. However, it is essential to carry out pharmacological prophylaxis against stone formation after bariatric surgery – this is prescribed by the treating physician after discharge. According to statistics, such an approach reduces the risk of gallstone formation by 40% [13].

Separately, the approach of “delayed cholecystectomy” should be considered, in which surgical treatment of gallstone disease is performed 6–12 months after body weight stabilization. This method allows for reduced risks and enables the surgery to be carried out under technically more favorable conditions [23].

Cholelithiasis (in most cases) is itself an indication for surgery – the removal of the gallbladder. If gallstones are detected in the gallbladder during preoperative evaluation before bariatric surgery, this is a reason to perform a simultaneous cholecystectomy along with the bariatric procedure to prevent complications associated with gallstone disease.

If there are no stones in the gallbladder, removal of a healthy gallbladder is not necessary. However, it is essential to carry out pharmacological prophylaxis against stone formation after bariatric surgery – this is prescribed by the treating physician after discharge. According to statistics, such an approach reduces the risk of gallstone formation by 40% [13].

Separately, the approach of “delayed cholecystectomy” should be considered, in which surgical treatment of gallstone disease is performed 6–12 months after body weight stabilization. This method allows for reduced risks and enables the surgery to be carried out under technically more favorable conditions [23].

During laparoscopic bariatric procedures, performing a cholecystectomy through the same access is technically possible; however, it requires experience and appropriate equipment. An alternative surgical method for gallstone disease (GSD) prophylaxis is the creation of a choledochoenterostomy, but due to its technical complexity and high risk, it is not used in bariatric surgical practice. There are also isolated reports of endoscopic lithotripsy and preventive papillotomy, but these methods have not gained wide acceptance [10].

In the event of complicated forms of GSD after bariatric surgery (choledocholithiasis, acute cholecystitis, biliary pancreatitis), emergency surgical intervention is indicated. Technical difficulties may arise due to altered gastrointestinal anatomy, especially after RYGB, requiring the involvement of an experienced surgeon [31].

Cholelithiasis (in most cases) is itself an indication for surgery – the removal of the gallbladder. If gallstones are detected in the gallbladder during preoperative evaluation before bariatric surgery, this is a reason to perform a simultaneous cholecystectomy along with the bariatric procedure to prevent complications associated with gallstone disease.

If there are no stones in the gallbladder, removal of a healthy gallbladder is not necessary. However, it is essential to carry out pharmacological prophylaxis against stone formation after bariatric surgery – this is prescribed by the treating physician after discharge. According to statistics, such an approach reduces the risk of gallstone formation by 40% [13].

Separately, the approach of “delayed cholecystectomy” should be considered, in which surgical treatment of gallstone disease is performed 6–12 months after body weight stabilization. This method allows for reduced risks and enables the surgery to be carried out under technically more favorable conditions [23].

During laparoscopic bariatric procedures, performing a cholecystectomy through the same access is technically possible; however, it requires experience and appropriate equipment. An alternative surgical method for gallstone disease (GSD) prophylaxis is the creation of a choledochoenterostomy, but due to its technical complexity and high risk, it is not used in bariatric surgical practice. There are also isolated reports of endoscopic lithotripsy and preventive papillotomy, but these methods have not gained wide acceptance [10].

In the event of complicated forms of GSD after bariatric surgery (choledocholithiasis, acute cholecystitis, biliary pancreatitis), emergency surgical intervention is indicated. Technical difficulties may arise due to altered gastrointestinal anatomy, especially after RYGB, requiring the involvement of an experienced surgeon [31].

The necessity of simultaneous cholecystectomy (CC) in patients with asymptomatic cholelithiasis undergoing bariatric surgery remains a subject of discussion. The risk of complicated gallstone disease (GSD) in bariatric patients with asymptomatic cholelithiasis is currently underestimated. Additional factors contributing to the development of choledocholithiasis include baseline BMI above 50 kg/m² and rapid weight loss (BMI reduction of more than 20 kg/m² per year). Experience from our clinic indicates that simultaneous CC in carriers of gallstones does not lead to an increase in complications, is more cost-effective, and is associated with improved quality of life for patients [17,18].

2. Conclusions

Thus, the choice of surgical prophylaxis strategy for GSD in bariatric patients should be individualized, taking into account the clinical situation, ultrasound findings, and laboratory parameters. The modern trend favors performing prophylactic cholecystectomy in the presence of risk factors or detected stones, especially when laparoscopic equipment and surgical expertise are available.