The hidden burden: incidentalomas detected on abdominopelvic computed tomography in bariatric surgery candidates - a single-center experience.

Bariatric surgery (BS) is currently one of the major breakthroughs in the management of patients with morbid obesity, showing outstanding long-term results. While an abdominopelvic computed tomography (CT) aims to analyze fat distribution and anatomical integrity during a preoperative evaluation, incidentalomas are unexpected tumors or abnormalities discovered by chance on imaging. The purpose of this study was to present our institution's experience with incidental findings detected during preoperative CT evaluations in patients who are candidates for BS. In our retrospective, observational study, we analyzed preoperative CT images from 131 patients eligible for BS and selected only those diagnosed with incidentalomas. Among the 29 obese patients (89.7% female; mean age, 39.0 ± 11.6 years; mean BMI, 38.5 ± 4.6 kg/m2) who were candidates for BS and had incidentalomas detected on a preoperative CT, a total of 64 lesions were identified, with a mean of 2.2 ± 1.3 per patient. A significant positive correlation was observed between age and the number of incidentalomas found (r = 0.52, P = 0.004), with hepatic involvement being the most common type (31.2%). In summary, our study highlights that incidentalomas are not mere chance occurrences but rather a valuable and common finding in this patient population. Their discovery can have a significant impact on surgical planning, potentially requiring a modified approach, further investigation, or even contraindicating the planned BS. The findings emphasize the importance of thorough preoperative CT evaluations for BS candidates.