OSAKA — A 35-year-old man from Tokyo died several hours after undergoing a sex-change operation in February at an Osaka clinic suspected of malpractice, sources close to the case said Tuesday.

The man, a company employee who lived in Koganei, western Tokyo, had suffered from a sexual-identity disorder and underwent the operation at Wada Keisei Clinic in Osaka’s Kita Ward on Feb. 25.

The five-hour operation began at 6:40 p.m. His condition deteriorated shortly afterward and he was taken to another hospital, where he was pronounced dead at around 6:35 a.m. the next day, the sources said.

The hospital reported the man’s death to authorities, suspecting malpractice at the clinic. Police performed an autopsy and confirmed fluid had accumulated in the man’s lungs, however they could not determine the exact cause of death.

Koji Wada, the clinic’s director, denied that the sex-change operation caused the man’s death. Investigators are now examining medical records submitted by the director, the sources said.

Wada told the investigators that he has performed three or four other sex-change operations, according to the sources.

Saitama Medical School Hospital and Okayama University Medical School Hospital are two other institutions that perform sex-change operations, but only after their ethics panels review and approve each case.

Medical experts say that there are between 2,000 and 7,000 people nationwide with sexual-identity disorder.

The sources also said a 39-year-old South Korean woman who had her jawbone scraped at the clinic died three weeks after surgery.

An autopsy could not determine the cause of her death.

The woman, who managed a restaurant, underwent the surgery Jan. 13 and died in the afternoon on Feb. 4 at another hospital. She also showed symptoms of lung edema, the sources said.

Wada said the woman was suffering from sleep apnea syndrome, they said. He declined further comment on the cases later Tuesday.

Wada opened the clinic, where he and four nurses work, in 1996.

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