Goal-directed fluid therapy (GDFT) improves postoperative outcomes in various surgeries, but the optimal fluid choice between balanced salt solutions (BSS) and hydroxyethyl starch (HES) remains debated. This meta-analysis compared postoperative outcomes of GDFT using BSS versus 6 ​% HES in elective major abdominal surgery. Comprehensive database searches identified eight RCTs (1739 patients) published between 2000 and 2024. No significant differences were found in overall postoperative complications [RR 1.04 (95 ​% CI 0.90–1.20); p ​= ​0.59], including renal, cardiovascular, respiratory complications, or mortality. However, BSS required significantly higher intraoperative fluid volumes [SMD 0.61 (95 ​% CI 0.42–0.80); p ​< ​0.001] and led to greater postoperative fluid balance [SMD 0.39 (95 ​% CI 0.20–0.59); p ​< ​0.001]. 6 ​% HES should not be used routinely. GDFT using BSS achieves the same outcomes at a lower cost and without the risk of bleeding.