Abstract
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.
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