Liver Biopsy During Bariatric Surgery: Safety and Bleeding Risks from MBSAQIP Data

Overview

Analysis of the 2020–2022 MBSAQIP database shows that performing liver biopsy concurrently with bariatric surgery does not significantly increase major complications or 30-day readmissions. However, there is a notable increase in transfusion requirements, indicating higher bleeding risk associated with the biopsy procedure.

Background

Morbid obesity is a major driver of Metabolic dysfunction–associated steatotic liver disease (MASLD), with prevalence rates up to 95% in bariatric surgery candidates. MASLD can progress to metabolic dysfunction-associated steatohepatitis (MASH), increasing risks of cirrhosis and hepatocellular carcinoma. Bariatric surgery not only aids weight loss but also improves MASLD histology. Liver biopsy remains the gold standard for diagnosing MASLD and assessing fibrosis, but concerns about bleeding complications have limited its routine use during bariatric procedures.

Data Highlights

Key Findings

• Concomitant liver biopsy during bariatric surgery does not significantly raise the 30-day major complication or mortality rates.
• There is no significant increase in 30-day hospital readmissions when liver biopsy is performed concurrently.
• Patients undergoing liver biopsy have a significantly higher need for blood transfusions postoperatively.
• Bleeding-related complications, including postoperative bleeding and reoperation for bleeding, are more frequent with liver biopsy.
• Multivariable analyses controlling for confounders confirm these findings, reflecting contemporary surgical practice from 2020–2022.

Clinical Implications

Surgeons should weigh the benefits of obtaining histological diagnosis via liver biopsy against the increased bleeding risk and transfusion requirements. While liver biopsy can provide critical diagnostic and prognostic information for MASLD and MASH, careful intraoperative hemostasis and postoperative monitoring are essential. These findings support the selective use of liver biopsy during bariatric surgery with appropriate precautions.

Conclusion

Intraoperative liver biopsy during bariatric surgery is generally safe without increasing major complications or readmissions but is associated with higher bleeding risk necessitating transfusions. This evidence informs surgical decision-making in managing MASLD in obese patients.

References

1. MBSAQIP Database Analysis 2020-2022 -- Liver Biopsy Safety in Bariatric Surgery