Background <p>Obesity is a worldwide epidemic and is pervasive in the liver disease community. Given that liver disease is both caused and worsened by obesity, our study assesses the risks of bariatric surgery in patients with chronic liver disease.</p> Methods <p>This retrospective study using the Metabolic and Bariatric Surgery Accreditation and Quality Improvement Program 2023 database includes adult patients who underwent minimally invasive sleeve gastrectomy, Roux-en-Y gastric bypass, or gastric band placement procedures. Liver disease (LD) includes a spectrum of severity (borderline to moderate) and etiologies (including steatosis). LD and non-liver disease (non-LD) cohorts were compared using Chi-square and t-tests. Univariate and multivariate analyses were performed using logistic regression.</p> Results <p>Our sample of 201,605 patients included 22,476 (11.2%) LD and 179,129 (88.9%) non-LD patients. Overall mean body mass index was 44.68&#xa0;kg/m² (SD 7.86). The mortality rates were no different between groups (0.07% and 0.07%, <i>p</i> = 0.85). While multivariate subset analyses of each procedure showed a statistically slightly elevated risk of bleeding, infection, bowel obstruction, Clavien-Dindo I-III complications, and ICU admission for the liver group patients (odds ratios ranged from 1.42–1.76), rates of complications were clinically very low (3.1% and 0.8% for Clavien-Dindo I-III and IV).</p> Conclusion <p>Given the low 30-day complication rate, our study shows that in the appropriate candidates with mild-to-moderate chronic liver disease, minimally invasive bariatric surgery is safe in the short-term, and the documented benefits of weight loss likely outweigh the slightly elevated risk. Bariatric surgeons can feel more comfortable and informed operating in this context.</p> Graphical Abstract <p></p>