Endocrine Abstracts

Introduction: The super-super-obese category of patient (BMI >60) tend to respond poorly to conservative weight interventions. Bariatric surgery is therefore considered the best form of intervention. Only a few UK centres have expertise to manage patients with a BMI >100kg/m² and careful counselling is essential as those standing to benefit the most from these procedures (through reduced risk of cardiovascular disease, diabetes and malignancy) also face the highest risk of morbidity and mortality. The first wave of Covid-19 presented the East Midlands Bariatric and Metabolic Institutes multidisciplinary team with multiple challenges to ensure that our very high risk patients could continue to safely access bariatric surgery. The combined Covid-19 and surgical risk were successfully minimised through careful planning of the management of patient, staff and the environment.

Case Summary: A 24 year old female with Class IV super super obesity (baseline BMI 109, 287kg) attended for consideration of surgical management. Her co-morbidities were lymphoedema, recurrent leg cellulitis and reduced mobility (wheelchair dependent). In preparation for surgery she undertook a tier 3 program followed by a pre-op very low calorie diet for 4 weeks liraglutide injections for 6 weeks. With this regime she attained a pre-op weight of 264kg (BMI 100). She underwent an uncomplicated laparascopic sleeve gastrectomy lasting 85 minutes with an uneventful post-operative recovery. At follow up 5 months after her operation she reports a total weight loss of 75.7kg with an excess weight loss of 34.1% (BMI of 80.5kg/m², 211.3kg). She is managing her early satiety well with small, frequent meals and has noted an improvement in her mood, better mobility and is keen to continue to increase her physical activity as lockdown restrictions ease.