Aim <p>This study aimed to conduct an updated systematic review and meta-analysis of comparative studies evaluating the efficacy and safety of tranexamic acid (TXA) during bariatric surgery.</p> Methods <p>Six databases were searched up to September 2, 2025. The primary endpoint was the rate of postoperative bleeding. Secondary endpoints included transfusion, hematoma, reoperation, thromboembolic events, operative time, and hospital stay. Outcomes were pooled as risk ratios (RR) or mean differences (MD) with 95% confidence intervals (CI) using a random-effects model.</p> Results <p>Ten studies (11 treatment arms; 2,137 patients, mostly undergoing laparoscopic sleeve gastrectomy) were included. TXA, usually given as a single intravenous dose at induction, was associated with a lower risk of postoperative bleeding (9 studies; RR 0.57, 95% CI 0.36–0.88), although this effect was not robust in leave-one-out sensitivity analyses. No significant differences were observed for blood transfusion, hematoma, or reoperation. TXA modestly reduced operative time and length of stay, but these differences were not clinically important. No thromboembolic events were reported in TXA-treated patients, and overall risk of bias was judged as low to moderate across most studies.</p> Conclusion <p>TXA may reduce postoperative bleeding, but the effect was not robust in sensitivity analyses; though further high-quality RCTs are needed.</p>