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OAGB with 200-cm BPL offers better weight loss vs 150-cm but more severe nutritional deficiencies

One anastomosis gastric bypass (OAGB) with a biliopancreatic limb (BPL) length of 200-cm results in better weight loss vs a BPL length of 150-cm however, this can result in more severe nutritional deficiencies but with no significant differences regarding remission of comorbidities, according to a systematic review and meta-analysis by an international team of researchers from the UK and Egypt.

Although OAGB is growing in popularity, there is no standardised biliopancreatic limb (BPL) length. Previous research has shown that an improperly long BPL can increase the risk of postoperative excessive loss of weight and developing nutritional deficiencies. Furthermore, there is a variation in the BPL length with BPL length of 200 and 150 cm both utilised, the authors noted.


As a result, they conducted a systematic review and meta-analysis to compare outcomes from OAGB patients who had a BPL length of 150 or 200-cm. The primary outcome was the difference in weight loss outcome. The secondary outcomes were the differences in comorbidities remission and nutritional deficiency rates.


In total, eight studies were included in the study, published from 2019 to 2022. The mean follow-up periods ranged from 10 to 44.87 months, in most of the studies the median follow-up period was 24 months. Five out of the six studies separated their cohort into two groups: 200 or 150-cm groups.

There were 2,599 patients – 1,100 (42.3%) underwent OAGB with a 150-cm BPL and 1,336 (51.4%) underwent OAGB with a 200-cm BPL. The remaining patients (n=111, 4.3%) underwent OAGB with variable BPL lengths so were not included in the analysis.

The pooled analysis revealed 200-cm BPL limb length was better for weight loss, with a statistically non-significant difference in the EWL% (p=0.67) and a highly significant difference in the TWL% (p=0.009). There were no statistically significant differences were found between the two groups in the percentages of diabetes mellitus resolution (p=0.78) or improvement (p=0.2). In addition, there were no statistically significant differences were noted in hypertension resolution (p=0.54) or improvement (p=0.24) percentages.


There was statistically significant difference between the two groups in the post-surgical ferritin (p=0.002) and folate (p=0.04) deficiency, but no statistically significant differences were found between the two groups in the other studied nutrients. There were no significant differences in the reoperation rates between the two groups (p=0.13).


“The present work, to our knowledge, is the first meta-analysis comparing OAGB using a 200-cm BPL to a 150-cm BPL…The current analysis reveals that the 200-cm BPL lengths had a superior weight loss outcome, namely the percentage of total weight loss, yet with a more severe nutritional deficiency. The lower weight loss outcome attributed to a 150-cm BPL is clinically questionable, with a mean TWL% difference of 2.6% and a mean EWL% of 0.9%m” the authors reported. “However, our findings imply the proper selection of compliant patients and the implementation of a strict surveillance programme if the patients will undergo OAGB with a 200-cm BPL.”


The findings were reported in the paper, ' One Anastomosis Gastric Bypass (OAGB) with a 150-cm Biliopancreatic Limb (BPL) Versus a 200-cm BPL, a Systematic Review and Meta-analysis', published in Obesity Surgery. To access this paper, please click here

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