Efficacy of Roux-en-Y Gastric Bypass and Sleeve Gastrectomy on Hepatic Steatosis and Fibrosis Markers: A Meta-analysis of Randomized Clinical Trials

Metabolic-associated steatotic liver disease (MASLD) and its complications represent a growing global health challenge. Both Roux-en-Y gastric bypass (RYGB) and sleeve gastrectomy (SG) have demonstrated long-term benefits for liver health and are currently recommended by international guidelines for patients with MASLD who meet surgical criteria. However, few randomized controlled trials (RCTs) have directly compared the hepatic effects of these commonly performed bariatric procedures in this population. A systematic search of PubMed, EMBASE, and Cochrane CENTRAL was conducted to identify RCTs evaluating RYGB and SG in patients with obesity and MASLD, with a minimum follow-up of 12 months. The primary outcome was the change in hepatic fibrosis, assessed by the number of patients with advanced fibrosis postoperatively. Secondary outcomes included changes in liver enzymes and body mass index (BMI). Meta-analyses were performed using Review Manager 5.4 and RStudio 4.1.2. Three RCTs comprising 322 patients (160 undergoing RYGB, 162 undergoing SG) were included. Both procedures significantly reduced the number of patients with advanced fibrosis: SG (OR = 4.10; 95% CI: 2.18–7.69; p < 0.0001) and RYGB (OR = 12.78; 95% CI: 5.21–31.37; p < 0.00001). While RYGB showed a higher overall odds of fibrosis improvement compared to SG (OR = 1.63; 95% CI: 0.94–2.81), this difference was not statistically significant (p = 0.08). No significant differences were found between groups in liver enzyme reductions. Both RYGB and SG significantly improved hepatic fibrosis in patients with MASLD, with RYGB demonstrating a stronger, albeit non-statistically significant, trend toward fibrosis resolution. Both procedures also reduced liver enzyme levels, reinforcing the role of metabolic surgery in improving liver-related outcomes in this population.