title: The role of a multidisciplinary approach in the choice of the best surgery approach in a super-super-obesity case.
abstract: BACKGROUND
  Obesity is a multifactorial chronic disease caused by a combination of hereditary, metabolic, dietary, cultural, social and psychological factors. Conservative treatments, such as diet and physical exercises, revealed a lack of long-term efficacy in patients with an extremely high BMI (>60 kg/m(2)).
  
  
  METHODS
  We present a multidisciplinary approach in a patient with an extremely high BMI: a twenty-one years old woman with a BMI 102 kg/m(2) (body weight 313 kg × height 175 cm) disabled to walk with severe depression and a psychological pattern of sweet eater and binge eating disorder. She was also amenorrheic and suffered from metabolic syndrome. The psychological assessment and the social-familial support were defined as priorities. Afterward, physical rehabilitation, behavior therapy, hypocaloric diet followed by intragastric balloon were planned as preoperative treatment. Finally a surgical program was scheduled: Sleeve Gastrectomy as first step of Biliopancreatic Diversion with Duodenal Switch.
  
  
  RESULTS
  Sixteenth months after the Sleeve Gastrectomy the weight was 130 kg (Excess Weight Loss = 74%) with a resumption of the menstrual cycle and a normalization of the metabolic syndrome.
  
  
  CONCLUSIONS
  Due to the results obtained with both surgery and an excellent psychological supporting network we decided not to perform the expected Biliopancreatic Diversion with Duodenal Switch. The timing of bariatric surgery in superobesity patients is a milestone, but the cooperation among the specialists is essential for the choice of the best successful surgery. The multidisciplinary team should point to a comprehensive tailored management, considering motivation, compliance and adherence to a long-term follow-up as the keys for surgical success.
authors.affiliation: University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
authors.forename: Giulio
authors.initials: G
authors.lastname: Orlando
authors.affiliation: University Magna Graecia of Catanzaro, 88100 Catanzaro, Italy.
authors.forename: Rita
authors.initials: R
authors.lastname: Gervasi
authors.affiliation: Gastroenterology and Endoscopy Unit, Annunziata Hospital, 87100 Cosenza, Italy.
authors.forename: Ileana M
authors.initials: IM
authors.lastname: Luppino
authors.affiliation: Dept of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy.
authors.forename: Mario
authors.initials: M
authors.lastname: Vitale
authors.affiliation: General Surgery Unit, University of Naples Federico II, 80100 Naples, Italy.
authors.forename: Bruno
authors.initials: B
authors.lastname: Amato
authors.affiliation: General Surgery Unit & Bariatric Center of Excellence-IFSO EC, Dept of Medical and Surgical Biotechnology and Sciences, University la Sapienza, 00100 Roma, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Silecchia
authors.affiliation: Dept of Medicine and Surgery, University of Salerno, 84084 Salerno, Italy. Electronic address: apuzziello@unisa.it.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Puzziello
mesh_terms: D000328:Adult; D050110:Bariatric Surgery / Q000379:methods*; D001521:Behavior Therapy; D015992:Body Mass Index; D003131:Combined Modality Therapy; D003865:Major Depressive Disorder / Q000209:etiology / Q000628:therapy; D004038:Diet, Reducing; D005260:Female; D005743:Gastrectomy / Q000379:methods; D015905:Gastric Balloon; D006801:Humans; D009767:Obesity, Morbid / Q000523:psychology / Q000601:surgery* / Q000628:therapy; D015431:Weight Loss
keywords: Bariatric surgery; Behavior therapy; Multidisciplinary approach; Super-super-obesity