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

  • Alireza Khalaj
  • Mohammad Ali Kalantar Motamedi
  • Pouria Mousapour
  • Majid Valizadeh
  • Maryam BarzinEmail author
Original Contributions



One-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.


Patients 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.


From 189 patients undergoing OAGB-MGB, seven patients (3.7%), all female, with a mean age of 46.4 ± 8.2 years and initial body mass index (BMI) of 44.2 ± 4.7 kg/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 ± 9.7 months after OAGB-MGB after failure of supportive measures. The mean BMI at the time of revision was 22.5 ± 2.6 kg/m2 with an excess weight loss of 109.2 ± 22.1%. 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 month and hypoalbuminemia and anemia normalized at 2 months.


A one-fits-all BPL length of 200 cm 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.


Bariatric surgery Mini-gastric bypass One-anastomosis gastric bypass Protein-energy malnutrition, surgical revision 



The author would like to thank Dr. M. Hassan K. Motamedi for his language edit of the manuscript.

Compliance with Ethical Standards

Conflict of Interest

The authors declare that they have no conflict of interest.

Ethical Approval

This study was approved by the institutional review board (no. IR.SBMU.ENDOCRINE.REC 1397.0592018-05-08). Informed consent was obtained from all individual participants included in the study. All procedures performed were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Alireza Khalaj
    • 1
  • Mohammad Ali Kalantar Motamedi
    • 2
    • 3
  • Pouria Mousapour
    • 3
  • Majid Valizadeh
    • 3
  • Maryam Barzin
    • 3
    Email author
  1. 1.Tehran Obesity Treatment Center, Department of Surgery, Faculty of MedicineShahed UniversityTehranIran
  2. 2.Department of Surgery at St. Paul’s HospitalUniversity of British ColumbiaVancouverCanada
  3. 3.Obesity Research Center, Research Institute for Endocrine SciencesShahid Beheshti University of Medical SciencesTehranIran

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