Key points
- Consider in MASLD with BMI ≥35, or 30–34.9 with metabolic disease (lower thresholds in Asian people).
- Randomised trial (BRAVES): MASH resolved at 1 year in 56–57% after surgery vs 16% with lifestyle and medical care.
- Long term: at 5 years, MASH resolved in 84% and fibrosis fell in 70% of re-biopsied patients.
- Compensated cirrhosis without portal hypertension: possible in expert centres.
- Avoid in decompensated cirrhosis.
For the evidence, graded recommendations, a case and self-test questions, read Module 3: The lifestyle prescription.
1Before surgery
- Stage fibrosis first. Unknown cirrhosis raises surgical risk.
- If cirrhosis is likely, assess portal hypertension (Baveno VII).
- Sleeve gastrectomy is often preferred in compensated cirrhosis.
2After surgery
- No alcohol: absorption changes and the risk of alcohol use disorder rises.
- Very fast weight loss can rarely worsen liver function. Watch closely in the first months.
- Keep up fibrosis follow-up.
Related topics
References
- EASL–EASD–EASO Clinical Practice Guidelines on the management of MASLD. J Hepatol 2024;81:492–542. doi:10.1016/j.jhep.2024.04.031
- Verrastro O, et al. Bariatric–metabolic surgery versus lifestyle intervention plus best medical care in NASH (BRAVES): a multicentre, open-label, randomised trial. Lancet 2023;401(10390):1786–97. doi:10.1016/S0140-6736(23)00634-7
- Lassailly G, et al. Bariatric surgery provides long-term resolution of NASH and regression of fibrosis. Gastroenterology 2020;159:1290–1301. doi:10.1053/j.gastro.2020.06.006
- Eisenberg D, et al. 2022 ASMBS and IFSO indications for metabolic and bariatric surgery. Surg Obes Relat Dis 2022;18:1345–56. doi:10.1016/j.soard.2022.08.013
- de Franchis R, et al. Baveno VII – Renewing consensus in portal hypertension. J Hepatol 2022;76:959–74. doi:10.1016/j.jhep.2021.12.022
How to cite this page
Desoky M. Metabolic and bariatric surgery. Metabolic Liver Academy quick reference, version 1.0. Updated 2026-10-03. Available from: https://drmahmouddesoky.github.io/metabolic-liver-academy/ref/surgery.html
A summary of published guidelines for healthcare professionals. It does not replace clinical judgement, the full guidelines or local drug labels. Disclaimer.