Background

This presentation outlines the successful execution of a team-based approach in performing a robotic sleeve gastrectomy on a 23-year-old male with a BMI of 173 (915 lbs.).The patient presented to the ED reporting right breast pain and a two-week history of ambulation difficulties. Subsequently, admission to the medical ward for right breast cellulitis, an exacerbation of atrial flutter leading to heart failure, acute kidney injury, and ongoing management of chronic medical issues.The patient's complex medical history included heart failure, atrial flutter, PE / DVT on anticoagulation, and obesity-related comorbidities, including OSA, Hypertension, and Pseudotumor Cerebri. Preoperative considerations involved clearances from cardiology, pulmonary, and vascular surgery, with specific attention to managing pulmonary hypertension and the high risk of pulmonary complications. Intraoperatively, meticulous planning addressed the patient's weight challenges, ensuring safe abdominal entrance, insufflation, and trocar selection.Postoperative care included delayed extubation, continued monitoring of fluid status and cardiac function, and the initiation of anticoagulation. The patient's postoperative course involved managing transient complications such as pulmonary edema and pulmonary hypertension.This case highlights the feasibility of safely performing gastric sleeve surgery on a super-obese patient and underscores the significance of a multidisciplinary team. The presentation emphasizes the importance of tailoring anticoagulant choices to individual patient needs and suggests that gastric sleeve procedures may effectively address associated comorbidities.In summary, this case underscores the successful integration of a collaborative team approach in managing a challenging bariatric surgery, offering insights into preoperative, intraoperative, and postoperative considerations for optimal patient outcomes.