Technical considerations of bariatric surgery in the superobese.

ariatric surgery (or surgery for obesity) is now well accepted as an effective means of weight control in selected patients with morbid obesity. Recently, we at the Mayo Clinic in Rochester, Minnesota, had the opportunity to operate on a patient weighing 780 lb (355 kg). An operation performed on so heavy an individual raised a number of technical factors and safety considerations we had not previously encountered. By careful multidisciplinary planning, the operation was carried out uneventfully. It would be wise for operating room personnel to develop a preconceived, preoperative care plan to deal with these very heavy patients, both under elective and emergent conditions. The goal of bariatric surgery is to offer the patient with morbid obesity the possibility of a longer, healthier life and an improved quality of life. Morbid obesity is defined as obesity complicated by medical "morbidity" such as premature degenerative arthritis, type II diabetes mellitus, hypertension, hyperlipidemia and its associated cardiac disease, potentially life-threatening sleep apnea, and other weightrelated medical problem^.'^ Obesity is termed "morbid obesity" when one's weight is greater than 100% above ideal body weight or at least 100 lb above ideal body weight. The goal of bariatric surgery in this patient population is to alter the anatomy of the upper gastrointestinal tract in such a way that it either physically prevents one from