The Significance of Routine Abdominal Ultrasound Before Bariatric Surgery

Background: Bariatric surgery is emerging as an absolute treatment for morbid obesity with long-lasting weight loss and comorbidity improvement due to the pandemic of obesity all over the world. Preoperative abdominal ultrasound is generally taken for identification of pathologic features to assist in surgical decision, although there is controversy over its role and clinical utility due to varying guideline practices and the absence of cost-effectiveness studies. Aim: This review estimates the efficacy of routine preoperative abdominal ultrasound for bariatric surgery on its basis of diagnostic yield, influence on surgical planning, cost-utility, and its ability to decrease perioperative complications as criteria. Methods: A Systematic literature review was conducted on PubMed, Embase, and Cochrane Library from January 2000 to April 2024 according to PRISMA guidelines. Studies in patients with BMI ≥30 kg/m² with primary bariatric surgery were taken into account. Extracts regarding data of ultrasound results, modification of surgical plan, and cost-effectiveness were matched, and the quality of studies was evaluated by STROBE and Jadad score. Results: Routine pre-operative ultrasound scanning will typically detect anomalies, for example, gallstones and fatty liver, but in no more than 7–15% of instances does this change surgical decision. Incidental diagnoses of malignancy are uncommon but important. Results: Technical challenges in grossly obese individuals and cost make routine use impossible, case selection for imaging is a more cost-effective alternative. Conclusion: Routine ultrasound has limited, focused utility in preoperative bariatric assessment. Focusing on usage, within clinical risk factors, would optimize benefit and resource utilization, pending further assessment on cost-effectiveness.