Protein-Calorie Malnutrition Requiring Revisional Surgery after One-Anastomosis-Mini-Gastric Bypass (OAGB-MGB): Case Series from the Tehran Obesity Treatment Study (TOTS)

Abstract

IntroductionOne-anastomosis-mini-gastric bypass (OAGB-MGB) is the second most popular gastric bypass procedure with remarkable weight loss results and comorbidity resolution rates. However, some concerns remain regarding its postoperative complications, including protein-calorie malnutrition (PCM). We hereby report our experience with patients who returned with severe PCM after OAGB-MGB.MethodsPatients with severe obesity presenting to our referral bariatric center underwent OAGB-MGB surgery using a 200-cm biliopancreatic limb (BPL) by a single surgical team at three university hospitals from March 2014 to February 2016.ResultsFrom 189 patients undergoing OAGB-MGB, seven patients (3.7%), all female, with a mean age of 46.4\u2009±\u20098.2\xa0years and initial body mass index (BMI) of 44.2\u2009±\u20094.7\xa0kg/m2, were readmitted for signs of PCM. Lower extremity edema, fatigue, excessive weight loss, hypoalbuminemia, anemia, and pancytopenia were the presenting symptoms and lab findings. Revisional surgery was performed at a mean 19\u2009±\u20099.7\xa0months after OAGB-MGB after failure of supportive measures. The mean BMI at the time of revision was 22.5\u2009±\u20092.6\xa0kg/m2 with an excess weight loss of 109.2\u2009±\u200922.1%. After revisional surgery, one patient developed profound liver failure and expired. Another patient developed severe steatohepatitis but ultimately recovered. In the remaining five, edema and fatigue completely resolved at 1\xa0month and hypoalbuminemia and anemia normalized at 2\xa0months.ConclusionA one-fits-all BPL length of 200\xa0cm is increasingly being questioned as it may result in an inadequate absorptive area and PCM in a subset of patients with shorter total bowel lengths, potentially placing them in danger and depriving them of bariatric surgery benefits.