Background

Bariatric surgery is the most effective treatment for obesity, especially in those patients with super super obesity (BMI > 50 kg/m2). The treatment of patients with this condition is a challenge for all the health care team. We are presenting a 33-year-old patient with tracheostomy, who is immobile since June 2019, history of BMI 142, type 2 diabetes mellitus, end stage renal disease, deep venous thrombosis and pulmonary embolism that requires Warfarin every day. Comes to the emergency department due to pain in both legs, bilateral lower extremities cellulitis and anemia. Treated by interdisciplinary teams involving family medicine, cardiology, pulmonology, infectious disease, ethics and consulted to general surgery for bariatric surgery evaluation. Patient underwent robotic assisted sleeve gastrectomy and discharged 7 months later due to social reasons for rehabilitation. Follow up shows a percent excess body weight loss of 54.9% with a BMI of 77.3 kg/m2. Treatment of super super obesity is challenging, needs a multidisciplinary team that can involve all aspects of the patient. Hospital infrastructure such as OR equipment needs to be well prepared for the correct management of the patient. Treating these patients makes a life change being able to modify not only metabolic aspects of life but also quality of their daily life.