Background/Aim: This study investigated the relationship between albumin-bilirubin (ALBI) grade and advanced liver fibrosis in patients with a history of gallstone disease and cholecystectomy, focusing on those diagnosed with metabolic dysfunctionassociated steatohepatitis (MASH) using the acMASH algorithm. Methods: Data from 566 subjects in the National Health and Nutrition Examination Survey 2017-2020 dataset were analyzed. MASH and advanced fibrosis (AF) were determined using acMASH and acFibroMASH algorithms, respectively. Liver stiffness measurement (LSM), ALBI grade, and other fibrosis indices were evaluated. Results: Of 566 subjects, 13 (2.3%) were diagnosed with MASH, and 65 (11.48%) had AF. MASH subjects showed significantly higher LSM values compared to non-MASH subjects (p=0.032). ALBI grade demonstrated weak positive correlations with LSM, FIB- 4, and acFibroMASH in non-MASH subjects. The AUROC for ALBI grade in identifying AF was 0.631 (95% CI 0.590-0.671). Multivariate analysis confirmed ALBI grade as an independent predictor of AF (odds ratio 0.193, 95% CI 0.1025-0.2837, p<0.001). Conclusions: ALBI grade shows potential as a non-invasive marker for advanced liver fibrosis in patients with a history of gallstone disease and cholecystectomy, particularly in those with MASH. Further studies with larger MASH cohorts are needed to validate these findings.