Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national…

Cohort studySurgery for obesity and related diseases : official journal of the American Society for Bariatric Surgery· Jul 2026

Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends.

Hector J Garcia Navas, Nicholas Dahlgren, Shubham Bhatia … Vance L Albaugh

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Bariatric & Metabolic SurgeryCohort studyClinical practiceQ1IF 2.1

Routine liver biopsy during bariatric surgery found steatohepatitis in nearly a third of patients.

Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends.

Hector J Garcia Navas … Vance L Albaugh

Surgery for obesity and related diseases · Jul 2026 · Q1 in Surgery

Background

The reliability of noninvasive methods to detect metabolic dysfunction-associated steatotic liver disease and metabolic-associated steatohepatitis (metabolic-associated steatohepatitis) or advanced liver disease remains uncertain.

Purpose

To test the hypothesis that routine liver biopsy (liver biopsy) during metabolic and bariatric surgery (metabolic and bariatric surgery) at an academic center would identify a high prevalence of metabolic-associated steatohepatitis with minimal operative risk.

Methods

Aged <18 years, open procedures, conversions/revisions, and missing biopsy results (institutional data) were excluded.

n = 980 institutional cases and 695,343

31.6%

Results

31.6%

steatohepatitis was already present in nearly a third, undetected before surgery

n = 980 institutional cases and 695,343

More results

Local routine liver biopsy prevalence was 48%, while national prevalence for liver biopsy was 3.5%.

Black race was associated with lower odds of steatosis (odds ratio [OR]: .34), metabolic-associated steatohepatitis (OR: .28), and fibrosis (OR: .45).

More results

In contrast, hypertension (OR: 1.93) and insulin-dependent diabetes (OR: 2.66) were associated with increased nonalcoholic steatohepatitis risk.

Postoperative complications were not different between routine liver biopsy and non-liver biopsy patients locally (P > .05).

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Conclusion · 1 of 2

Metabolic dysfunction-associated steatotic liver disease/metabolic-associated steatohepatitis is highly prevalent in metabolic and bariatric surgery.

Conclusion · 2 of 2

Not only is liver biopsy safe and not risk prohibitive but it also identifies advanced liver disease that is generally poorly detected preoperatively and can affect postoperative treatment and outcomes.

Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends.

Intraoperative liver biopsy during metabolic and bariatric surgery: diagnostic yield, safety, and national trends.

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