AIIMS Gives New Lease Of Life To 209-kg Man After High-Risk Weight-Loss Surgery

For nearly five years, life had shrunk to a bedroom for a 32-year-old man from Delhi's Karawal Nagar. Once able to move around independently, he gradually became trapped inside a body that weighed 209 kg.

Walking even a few steps left him breathless. Climbing stairs became impossible. Most of his day was spent sleeping, while nights were punctuated by repeated episodes in which he stopped breathing because of severe obstructive sleep apnoea.

As his weight spiralled out of control, so did his health, pushing him into respiratory failure and depression.

"I could hardly walk. Even simple daily activities became a struggle. Breathing was difficult all the time, and I depended on machines to stay alive. There were moments when I felt there was no hope," the patient recalled after his recovery.

His condition became so critical that doctors at the All India Institute of Medical Sciences (AIIMS), New Delhi, had to perform an emergency tracheostomy inside the operating theatre after he failed to maintain adequate oxygen levels despite continuous positive airway pressure (CPAP) support. For more than a month, he remained dependent on CPAP delivered through the tracheostomy while doctors worked to make him fit for a surgery that initially appeared impossible.

When the patient first consulted doctors, he weighed 181 kg with a BMI of 64. Within weeks, after postponing surgery, his weight shot up to 209 kg, his BMI climbed to 74 kg/m², and his abdominal girth reached 198 cm. Alongside morbid obesity, he suffered from hypertension, prediabetes, dyslipidaemia, gastro-oesophageal reflux disease, bilateral knee pain, depression and severe obstructive sleep apnoea.

According to Dr. Naval Vikram, Professor, Department of Medicine, AIIMS, obesity had triggered a cascade of life-threatening medical complications.

"This was not merely a case of excessive weight. The patient had multiple obesity-related disorders, including severe sleep apnoea, respiratory failure, hypertension, prediabetes, dyslipidaemia and depression. His respiratory status had deteriorated to a point where maintaining oxygen saturation became extremely challenging," he said.

The patient’s enormous body size created another obstacle. The patient's abdominal girth was so large that he could not be safely positioned on a conventional operating table, making laparoscopic bariatric surgery virtually impossible.

Rather than abandoning surgery, AIIMS assembled a multidisciplinary team comprising bariatric surgeons, physicians, anaesthesiologists, intensivists, pulmonologists, psychiatrists, physiotherapists, infection-control specialists and dietitians. Their goal was not immediate surgery but meticulous preoperative optimisation.

"The biggest challenge was not simply the patient's weight but his compromised respiratory status and body habitus. Operating immediately would have carried unacceptable risks. We therefore focused on stabilising his airway and optimising him medically before attempting surgery," said Dr. Nikhil Agrawal, Professor, Department of Surgical Disciplines, AIIMS.

The patient underwent an intensive 32-day optimisation programme, including a very low-calorie diet (VLCD), respiratory physiotherapy, nutritional counselling and infection-control measures.

According to Dr. Richa Jaiswal, Senior Dietitian at AIIMS, nutrition became as important as surgery itself.

"The patient strictly followed a medically supervised very low-calorie diet. Besides achieving substantial weight loss, the programme helped reduce abdominal fat, improve respiratory mechanics and prepare him metabolically for surgery. Patient compliance played a crucial role in the outcome," she said.

The transformation was dramatic. His weight reduced from 209 kg to 172 kg, while his abdominal girth fell from 198 cm to 178 cm.

According to Dr. Manjunath Maruti Pol, Professor, Department of Surgery, this reduction in abdominal girth proved more valuable than the weight loss itself.

"Perhaps the most striking observation was the reduction in abdominal girth after only 32 days of VLCD. That reduction was clinically more important than the absolute weight loss because it allowed safe positioning on the operating table and significantly improved respiratory mechanics," he explained.

Dr. Pol said the patient's inability to maintain oxygen saturation despite CPAP had necessitated a tracheostomy before definitive surgery could even be contemplated.

"This case demonstrates that pre-operative multidisciplinary optimisation with airway stabilisation and a structured VLCD programme can transform an otherwise inoperable patient with super-super obesity into a suitable candidate for bariatric surgery," he said.

Once stabilised, surgeons performed a laparoscopic One Anastomosis Gastric Bypass (OAGB) on July 24, completing the technically demanding procedure in two hours and ten minutes without major complications.

Recovery exceeded expectations. Over the following days, the patient was gradually weaned off CPAP. By the 13th postoperative day, he was breathing independently, walking without assistance and performing his daily activities on his own. Before discharge, his weight had fallen further to 160 kg, while his abdominal girth reduced to 155 cm.

"I feel as though I have been given a second chance. Earlier, I could barely move, but now I can walk again. The doctors have told me that if I continue with lifestyle changes and regular follow-up, my weight could eventually come down to around 70 kg. I never imagined that would be possible," the patient said.

The treating team believes the case has important implications for obesity management in India, where the burden of severe obesity is rising steadily.

"Super-super obesity associated with prolonged CPAP dependence and tracheostomy should not be considered an absolute contraindication to bariatric surgery. With a structured multidisciplinary programme involving nutrition, respiratory stabilisation, meticulous operative planning and rehabilitation, such patients can safely undergo definitive metabolic surgery," Dr. Pol said.