Impact of Biopsy-proven Hepatic Fibrosis and Steatohepatitis on Short-term Weight-loss Outcomes after Sleeve Gastrectomy

Abstract

Background: Metabolic Dysfunction-Associated Steatohepatitis (MASH) and hepatic fibrosis are common in patients undergoing sleeve gastrectomy (SG). Whether histological liver injury influences postoperative weight loss remains uncertain. This study examined the association of biopsy-proven MASH and fibrosis severity with 12-month weight-loss outcomes after SG.

Methods: We retrospectively analyzed 417 patients who underwent SG with intraoperative liver biopsy. Steatosis, inflammation, and ballooning were graded by the NAFLD Activity Score, and fibrosis was staged F0-F4. Weight-loss outcomes included total weight loss (%TWL), excess weight loss (%EWL), and attainment of the expected BMI (eBMI). Logistic regression identified factors associated with eBMI and ≥ 50%EWL achievement.

Results: At 12 months, patients with MASH and those without achieved comparable percentage of %TWL and %EWL (32.08 vs. 30.23%; 88.64 vs. 93.82%). Fibrosis severity, rather than MASH status, showed an association with individualized BMI attainment, whereas proportional weight-loss outcomes (%TWL and %EWL) did not differ significantly across fibrosis stages.

Conclusions: In this biopsy-confirmed SG cohort, MASH did not affect short-term weight loss, whereas moderate fibrosis was linked to greater likelihood of reaching individualized BMI targets.

Keywords: Expected BMI; Hepatic fibrosis; Metabolic-associated steatohepatitis; Sleeve gastrectomy; Weight loss outcomes.