Abstract Background incidental intra-abdominal findings during bariatric surgeries can benefit obese patients beyond their metabolic or bariatric conditions. Since obese patients are at an increased risk of such findings, bariatric surgeons should actively survey the patients for them. This study evaluates the role of routine lower abdominal diagnostic laparoscopy in identifying and managing such findings during sleeve gastrectomy (SG) in a high-risk obesity cohort. Methods A retrospective multicentre study analysed 371 patients undergoing SG with concurrent diagnostic laparoscopy at three specialized centres in Tripoli, Libya (January 2021–December 2024). Diagnostic laparoscopy involved systematic exploration using a 180° camera rotation in a 45°reverse Trendelenburg position. Data on demographics, incidental findings, interventions, operative times, and outcomes were collected. Results Incidental findings were detected in 6.5% (n = 24/371), including cysts/masses (45.8%, n = 11), adhesions (29.2%, n = 7), hernias (16.7%, n = 4), and other pathologies (8.3%, n = 2). The findings lead the abortion of 1 procedure, the identification of one precancerous mass, and the rescheduling 2 SG surgeries. Median operative time increased by 3 to 7 minutes, with no mortality related to laparoscopy. Two cases with findings of indirect inguinal hernia required emergency intervention within 90 days of identification of findings. Patients with interventions had a marginally longer hospital stay (3.5 versus 2–3 days) but 85% achieved full recovery. Preoperative imaging (ultrasound) failed to identify 100% of findings later detected laparoscopically. Conclusion Routine diagnostic laparoscopy during SG is feasible, safe, and critical for detecting occult pathologies in obese patients. Its integration added minimal operative time (3–7 minutes) while enabling timely interventions that likely mitigated long-term morbidity. These findings advocate for standardizing diagnostic laparoscopy in bariatric protocols to enhance patient safety, particularly in populations with limited preoperative diagnostic accuracy. Keywords: Incidental findings, bariatric surgery, diagnostic laparoscopy, sleeve gastrectomy, intraoperative management
Saleh Abujamra (Thu,) studied this question.