‘Bridging Therapy’ as a Preoperative Strategy for Bariatric Surgery in Super-Super Obesity: A Report of Two Cases

The rising prevalence of super-super obesity (BMI ≥ 60 kg/m²) poses a major clinical challenge, facing the highest comorbidity burden interfering with bariatric surgery. Safe strategies to reduce surgical risk in this population are required. This case report aims to demonstrate the efficacy of a structured preoperative ‘bridging therapy’ in enabling safe bariatric surgery and improving outcomes in patients with super-super obesity. Patient A: 30-year-old female (BMI 79.3 kg/m², 203 kg) with multi-organ failure, type 2 diabetes, obstructive sleep apnea, and pulmonary hypertension. Patient B: 39-year-old male (BMI 76.2 kg/m², 251 kg) with severe obstructive sleep apnea, fatty liver disease, grade 3 hypertension, and hyperlipidemia. A ‘bridging therapy’ was instituted for the patients, encompassing an individualized diet and exercise regimen. Continuous Positive Airway Pressure (CPAP) treatment was administered for nocturnal ventilatory dysfunction. Concurrently, a standardized pharmacological regimen was initiated, including hypoglycemic, antihypertensive agents to manage metabolic derangements and improve cardiac function. When the weight was effectively reduced, bariatric surgery was performed to reduce weight more remarkable. At 12 months postoperatively, Patient A lost 121 kg (TWL59.6%), and Patient B lost 145 kg (TWL57.8%). Both patients showed significant improvement or normalization of obesity-related comorbidities during the 12-month follow-up, with discontinuation of hypoglycemic and antihypertensive medications. In super-super obesity, a multidisciplinary bridging therapy is key to minimizing operative risk. Expedited surgery is not advised; structured preoperative weight loss is paramount to improve baseline organ function and surgical candidacy.