This case presents a young gentleman, who started with a body mass index (BMI) of 64 and got it down to 58. Typically patients with a BMI of 50 or higher, especially if they have central obesity, as in this patient, are a little more challenging than others. The challenges are the torque the physician will feel in the abdominal wall, which is why the robot is helpful in these types of cases. There are some caveats for a sleeve gastrectomy: the achilles heel of a sleeve gastrectomy is reflux, heartburn, or GERD. It is important to make sure that these patients don't have a hiatal hernia preoperatively. Dr. Shouhed typically likes to do an endoscopy afterwards to make sure that the sleeve is nice and straight, there aren't any areas that are too narrowed, and to make sure there's no intraluminal bleeding.
