Perioperative considerations when operating on the very obese: tricks of the trade.

Obesity is the leading public health concern in the industrialized world with the advent of the very obese or "super obese" increasing exponentially. Bariatric surgery remains the only effective and enduring treatment for morbid obesity and can be safely accomplished in experienced centers. Surgery in the very obese may be considered high-risk: however, this risk may be managed with an experienced bariatric surgery team, appropriate anesthetic consideration, preoperative risk assessment, employment of venothrombotic event prevention, preoperative weight loss, and understanding of particular anatomic considerations. With appropriate preparation, the very obese surgical patient can achieve safe and effective surgical outcomes.