209 kg and a weight-loss programme: How 'obese' patient was prepped for surgery at AIIMS Delhi

A 32-year-old man from Karawal Nagar, Delhi, weighing 209 kg, underwent a successful bariatric surgery at the All India Institute of Medical Sciences (AIIMS) in New Delhi. The operation, which took place on July 24, marked a critical milestone in treating patients with severe obesity, demonstrating how a multidisciplinary approach can prepare such individuals for life-saving procedures. At the outset of his treatment, the patient had a body mass index (BMI) of 64, indicating severe obesity. Over the course of approximately one month, his weight increased to 209 kg, pushing his BMI to 74 and expanding his abdominal girth to 198 cm. These measurements made it impossible for him to lie safely on a standard operating table, presenting a significant challenge for the surgical team. Additionally, the patient suffered from several comorbidities including hypertension, prediabetes, severe obstructive sleep apnea, depression, dyslipidemia, gastroesophageal reflux disease, and bilateral knee pain. His condition worsened to the extent that he could not maintain adequate oxygen saturation levels even while using continuous positive airway pressure (CPAP) therapy. To address these challenges, the medical team initiated a comprehensive preoperative optimization plan. The patient was placed on a very low-calorie diet (VLCD) for 32 days, along with respiratory physiotherapy, infection control measures, and nutritional counseling. During this period, he was under the care of a multidisciplinary team consisting of physiotherapists, intensivists, psychiatrists, nutritionists, bariatric surgeons, pulmonologists, and anaesthesiologists. As a result of this intensive intervention, his weight dropped from 209 kg to 172 kg, and his abdominal girth decreased from 198 cm to 178 cm. This reduction proved crucial, allowing for safe positioning during surgery and improving his respiratory function. On the day of the operation, the patient was prepared for a laparoscopic One Anastomosis Gastric Bypass (OAGB). The procedure lasted two hours and ten minutes and was conducted without encountering major complications. Following the surgery, the patient continued to show improvement, with further reductions in his abdominal girth. The outcome underscores the importance of a structured, multidisciplinary approach in managing cases of super-super obesity, particularly when patients require long-term CPAP support and have undergone tracheostomy. This case highlights the potential of advanced medical interventions to overcome seemingly insurmountable obstacles. By combining dietary management, respiratory stabilization, and careful surgical planning, the team at AIIMS successfully transformed an inoperable patient into a viable candidate for bariatric surgery. The patient’s progress serves as a testament to the power of collaborative medical care in addressing complex health conditions.