Abstract
BACKGROUND: One anastomosis gastric bypass (OAGB) is safe and effective treatment for patients with severe obesity. OAGB with a biliopancreatic limb (BPL) of 200-250 cm often leads to metabolic and nutritional issues, which may be mitigated by using a shorter biliopancreatic limb (BPL) length (170-180 cm). However, the impact of shorter BPL lengths on efficacy remains uncertain. METHODS: A retrospective cohort study was conducted on patients who underwent OAGB at two Iranian centers between March 2018 and March 2021. Patients were divided into two groups based on BPL length: 170-180 cm and 200-250 cm. Groups were compared for weight loss, nutritional status, and comorbidity resolution over two years. RESULTS: Both groups achieved comparable weight loss (BMI reduction: 28.4 vs. 28.3 kg/m², p = 0.913), with complete hypertension resolution observed in 95.6%of hypertensive patients and complete diabetes remission in 90% of diabetic patients. Nutritional outcomes were comparable between groups (albumin, vitamin D, B12), though ferritin levels were numerically lower in the 200-250 cm group. Despite concerns about malnutrition following OAGB, our findings demonstrate that a 170-180 cm BPL achieves weight loss and comorbidity resolution comparable to a 200-250 cm BPL, with reduced nutritional risks. CONCLUSION: OAGB with a 170-180 cm BPL yields weight loss and comorbidity resolution comparable to a 200-250 cm BPL, with potentially fewer nutritional deficiencies.