The Super Super-Obese

  • Kelvin D. Higa
  • Alan C. Wittgrove


The prevalence of morbid super-obesity (BMI > 50 kg/m2) is continuing to increase despite a leveling off of class 1 and 2 obesity. These patients present a challenge, surgically, as well as programmatically, and represent the highest risk and lowest success rates. However, with proper preoperative preparation and in the appropriate institution, safe and effective treatment options can be delivered.


Morbid super-obesity Class 3 obesity Sleeve gastrectomy Gastric bypass Duodenal switch 


  1. 1.
    Sturm R, Hattori A. Morbid obesity rates continue to rise rapidly in the United States. Int J Obes. 2013;37(6):889–91.CrossRefGoogle Scholar
  2. 2.
    Higa K, Ho T, Tercero F, Yunus T, Boone K. Laparoscopic Roux-en-Y gastric bypass: 10 year follow-up. Surg Obes Relat Dis. 2011;7:516–25.CrossRefPubMedGoogle Scholar
  3. 3.
    Edholm D, Kullberg J, Haenni A, et al. Preoperative 4-week low calorie diet reduces liver volume and intrahepatic fat, and facilitates laparoscopic gastric bypass in morbidly obese. Obes Surg. 2011;21:345–50.CrossRefPubMedGoogle Scholar
  4. 4.
    Busetto L, Segato G, De Luca M, et al. Preoperative weight loss by intragastric balloon in super-obese patients treated with laparoscopic gastric banding: a case-control study. Obes Surg. 2004;14:671–6.CrossRefPubMedGoogle Scholar
  5. 5.
    Coffin B, Maunoury V, Pattou F, et al. Impact of intragastric balloon before laparoscopic gastric bypass on patients with super obesity: a randomized multicenter study. Obes Surg. 2017;27:902–9.CrossRefPubMedGoogle Scholar
  6. 6.
    Sinha A, Jayaraman L, Punhani D, Chowbey P. Enhanced recovery after bariatric surgery in the severely obese, morbidly obese, super-morbidly obese and super-super morbidly obese using evidence-based clinical pathways: a comparative study. Obes Surg. 2017;27:560–8.CrossRefPubMedGoogle Scholar
  7. 7.
    Peterson K, Anderson J, Boundy E, Ferguson L, Erickson K. Rapid evidence review of bariatric surgery in super obesity (BMI ≥ 50 kg/m2). J Gen Intern Med. 2017;32(Suppl 1):56–64.CrossRefPubMedPubMedCentralGoogle Scholar
  8. 8.
    Celio A, Wu Q, Kasten K, Manwaring M, Pories W, Spaniolas K. Comparative effectiveness of Roux-en-Y gastric bypass and sleeve gastrectomy in super obese patients. Surg Endosc. 2017;31:317–23.CrossRefPubMedGoogle Scholar

Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  • Kelvin D. Higa
    • 1
  • Alan C. Wittgrove
    • 2
  1. 1.Minimally Invasive and Bariatric SurgeryFresno Heart and Surgical HospitalFresnoUSA
  2. 2.Wittgrove Bariatric CenterDel MarUSA

Personalised recommendations