A 32-year-old man weighing 209 kilograms has successfully undergone bariatric surgery at the All India Institute of Medical Sciences (AIIMS) in Delhi. The procedure was possible only after a dedicated multidisciplinary team of doctors managed to reduce the patient’s weight and stabilize his critical respiratory condition, which initially made him too large for standard operating tables.
Information was available with The Chenab Times that the patient, a resident of Karawal Nagar in Delhi, was referred for bariatric surgery due to a progressive increase in his weight over several years. At his initial consultation, his weight was recorded at 181 kg with a Body Mass Index (BMI) of 64. However, during the month he delayed his decision to undergo surgery, his weight escalated to 209 kg, pushing his BMI to 74 and his abdominal girth to an alarming 198 cm.
His health issues were compounded by severe obstructive sleep apnea, hypertension, prediabetes, dyslipidaemia, gastroesophageal reflux disease, depression, and bilateral knee pain. His respiratory condition deteriorated to a point where he could not maintain adequate oxygen saturation even with continuous positive airway pressure (CPAP) support.
Doctors at AIIMS initiated a critical intervention by inserting an endotracheal tube and subsequently performing an emergency tracheostomy directly on the patient’s bed within the operating theatre. This measure was deemed necessary due to the anticipated need for prolonged ventilatory support and the impossibility of safely positioning him on a standard operating table owing to his extreme body habitus and abdominal dimensions.
The patient remained reliant on CPAP support via the tracheostomy for 32 days. During this period, he was managed by a comprehensive team comprising bariatric surgeons, anaesthesiologists, pulmonologists, intensivists, nutritionists, psychiatrists, and physiotherapists. His treatment regimen included a 32-day very low-calorie diet (VLCD), respiratory physiotherapy, strict infection control protocols, and extensive nutritional counselling.
This intensive pre-operative optimization resulted in a significant reduction in his weight, from 209 kg to 172 kg, and a decrease in his abdominal girth from 198 cm to 178 cm. Crucially, this reduction in girth was more impactful clinically than the absolute weight loss, as it facilitated safer positioning on the operating table with the use of side-table extensions and significantly improved his respiratory mechanics.
Following this preparatory phase, doctors were able to proceed with a laparoscopic One Anastomosis Gastric Bypass (OAGB) procedure on July 24. The surgery, which lasted two hours and ten minutes, was completed without any major complications.
Post-operatively, the patient’s respiratory support was gradually weaned as his weight stabilized around 160 kg. By the 13th day after surgery, he was breathing independently, ambulating on his own, had resumed self-care activities, and reported a substantial improvement in his overall quality of life. His abdominal girth had further reduced to 155 cm.
Doctors highlighted that super-super obesity, particularly when associated with prolonged CPAP dependence and tracheostomy, should not be considered an absolute contraindication for bariatric surgery. They emphasized that a structured, multidisciplinary optimization program, incorporating prolonged VLCD, respiratory stabilization, nutritional support, and meticulous surgical planning, can effectively prepare such high-risk patients for metabolic surgery.
The patient himself described the profound impact of his obesity on his daily life, stating that he had gained significant weight over the preceding four to five years, which made even simple activities like walking extremely difficult. He spent most of his time sleeping, experienced severe breathing issues, and continued to gain weight, exacerbated by a habit of overeating and an ongoing struggle with depression.
He expressed his relief and newfound mobility, stating, “Earlier, I could hardly walk and even simple activities were a struggle. Now I am able to walk again.” He added that his doctors have informed him that with continued weight loss and follow-up care, his weight could potentially reach around 70 kg in the future, marking a transformative journey from extreme obesity to a path of recovery and improved health.
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