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

Alireza Khlaj | Mohammad Ali Kalantar Motamedi | Pouria Mousapour | Majid Valizadeh | Maryam Barzin

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URL :   http://research.shahed.ac.ir/WSR/WebPages/Report/PaperView.aspx?PaperID=137919
Date :  2019/02/01
Publish in :    Obesity Surgery: The Journal of Metabolic Surgery and Allied Care
DOI :  https://doi.org/10.1007/s11695-019-03741-7
Link :  http://dx.doi.org/10.1007/s11695-019-03741-7
Keywords : Bariatric surgery . Mini-gastric bypass . One-anastomosis gastric bypass . Protein-energy malnutrition, surgical revision

Abstract :

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Introduction 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. Methods PatientswithsevereobesitypresentingtoourreferralbariatriccenterunderwentOAGB-MGBsurgeryusinga200-cm biliopancreatic limb (BPL) by a single surgical team at three university hospitals from March 2014 to February 2016. Results From 189 patients undergoing OAGB-MGB, seven patients (3.7), all female, with a meanage of 46.4±8.2 years and initialbodymassindex(BMI)of44.2±4.7kg/m2,werereadmittedforsignsofPCM.Lowerextremityedema,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 supportivemeasures. The meanBMI 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. Conclusion Aone-fits-allBPLlengthof200cmisincreasinglybeingquestionedasitmayresultinaninadequateabsorptivearea and PCM in a subset of patients with shorter total bowel lengths, potentially placing them in danger and depriving them of bariatric surgery benefits.