Laparoscopic sleeve gastrectomy is the most widely performed bariatric procedure across the world. It leads to significant weight loss and improvement of quality of life in patients with obesity. Patients undergoing bariatric surgery have an increased risk of gallstone formation due to changes in hepatic cholesterol metabolism and reduced gallbladder motility. This chapter explores the relationship between sleeve gastrectomy and biliary disease focusing on the incidence of gallstones, the role of prophylactic cholecystectomy, and the potential benefits of pharmacological interventions such as ursodeoxycholic acid on preventing complicated biliary disease following bariatric surgery. We also discuss the management of gallbladder-related complications such as biliary colic, cholecystitis, choledocholithiasis, pancreatitis, and bile duct injuries which can occur during or after surgery. Understanding the biliary considerations in sleeve gastrectomy patients is crucial for minimizing complications and improving long-term outcomes for patients undergoing bariatric surgery.