Background: Cholelithiasis is a common complication after bariatric surgery. Pure restrictive procedures such as sleeve gastrectomy and gastric banding theoretically should result in less gallstone formation because the food continues to follow the normal gastrointestinal transit, maintaining the enteric–endocrine reflex intact. Gallstone diseases are one of the most common complications of obesity and after bariatric surgery with multiple risk factors. The role of prophylactic cholecystectomy at the time of bariatric surgery remains controversial. The fact that pathologic evidence of gallbladder diseases has been found in more than 75% of routinely resected specimens supports those who advocate prophylactic cholecystectomy.