Abstract
BACKGROUND: Severe intraabdominal adhesions and ventral hernias pose significant technical challenges in bariatric surgery, especially in patients with a history of complex abdominal procedures. CASE SUMMARY: This report describes a case involving a 30-year-old morbidly obese man who previously underwent a right lobe hepatectomy for living donor liver transplantation. The patient presented with a body mass index of 40.7 kg/m(2) and a giant incisional hernia, compounded by extensive intraabdominal adhesions from multiple previous surgeries. A laparoscopic sleeve gastrectomy was performed as the initial step of a staged surgical plan. Adhesiolysis was conducted carefully to address the dense intraabdominal adhesions, and the procedure was completed successfully using standard stapling techniques. Postoperative recovery was smooth, with significant weight loss achieved within the first month. CONCLUSION: This case highlights the need for personalized surgical planning and precise techniques in bariatric surgery for patients with past abdominal operations.