Secondary aortoenteric fistula is a rare and life-threatening complication following aortic reconstructive surgery, most commonly involving the duodenum. Erosion of an aortofemoral bypass graft into the sigmoid colon is exceptionally uncommon; all reported cases were managed via open surgery with significant morbidity. Laparoscopic management with graft preservation has not been documented. A 59-year-old man presented with massive hematochezia 9 months after bilateral aortobifemoral bypass for an abdominal aortic and common iliac aneurysm. Colonoscopy revealed a vascular graft 25 cm from the anal verge. Computed tomography confirmed penetration of the graft into the sigmoid lumen without abscess or contrast extravasation. The patient underwent laparoscopic sigmoid colectomy with graft preservation and peritoneal coverage, followed by colorectal anastomosis and defunctioning ileostomy. He was discharged on postoperative Day 7. He was maintained on a 6-week course of targeted oral antimicrobial therapy. At 6-month follow-up, the patient remains well with a patent graft, no recurrent bleeding, and no graft-related complications. This case highlights the feasibility of minimally invasive management and selective graft preservation in carefully selected patients, challenging the paradigm of mandatory graft excision.

Introduction: The management of gallbladder disease during metabolic and bariatric surgery (MBS) remains controversial. Cholelithiasis is common in patients with obesity, yet the approach to concomitant or prophylactic cholecystectomy varies, with limited data from Egypt. This study aimed to assess Egyptian bariatric surgeons’ practices, attitudes, and decision-making regarding cholecystectomy during MBS. Methods: A national cross-sectional survey was distributed to bariatric surgeons in Egypt, collecting information on demographics, surgical experience, preoperative screening, intraoperative decision-making, postoperative management, and prophylactic practices. The questionnaire included structured, closed-ended questions. Data were analyzed descriptively and compared between IFSO members and non-members using chi-square or Fisher’s exact tests, with p < 0.05 considered significant. Results: A total of 117 surgeons participated, predominantly male (99%), with 16.2% IFSO members. Bariatric surgery was concentrated in Cairo (42%) and Alexandria (26%). Most surgeons (97%) screened gallstones preoperatively using abdominal ultrasound. Concomitant cholecystectomy was preferred for documented gallstones by 78%, while 82% never performed prophylactic cholecystectomy in patients with normal gallbladders. The majority performed the bariatric procedure first (82%) in reverse Trendelenburg position (88%), minimizing additional ports. Routine intraoperative cholangiography was rare (1.7%). Postoperative management largely mirrored isolated bariatric surgery, although antibiotic and drain practices differed between groups. Surgeons generally perceived combined procedures as safe, with 76% reporting no increase in complications and 89% reporting similar length of stay. Conclusion: Egyptian bariatric surgeons consistently screen for gallstones and favor concomitant cholecystectomy for documented stones, while largely avoiding prophylactic removal of normal gallbladders. Variation exists in intraoperative management and postoperative care. These findings highlight areas for standardization and support the development of a national pathway and multicenter registry to optimize gallbladder management in MBS.