Introduction. Super obese group of patients with body mass index (BMI) ?
50kg/m2 have higher technical intraoperative problems, higher morbidity and
mortality. Indications for the metabolic procedure are widening and
minimally invasive operation dictate both patients and surgeons to face with
previously assumed ?general contraindication? for surgical
bariatric/metabolic procedure. Case outline. We present a super obese
patient with restenosis of the trachea, chronic obstructive pulmonary
disease, sleep apnea and cardiomyopathy with panniculus grade IV, in whom as
a multidisciplinary team we did simultaneously permanent tracheostomy,
laparoscopic sleeve gastrectomy and panniculectomy. Conclusion. Quality of
life after the bariatric operation is a factor which must be leading in
concern how to approach a difficult patient, with operation adaptable to fit
all demands.