BACKGROUND AND AIMS: The population with a BMI of 70kg/m2 or greater has been described and categorized as mega-obese. Mega-obese patients weighing more than 250kg constitute a special group of mega-obese patients that present more intra- and post-operative problems than other suprasuperobese.MATERIAL AND METHODS: This is a retrospective analysis of 7 mega-obese patients weighing more than 250 kg, who underwent bariatric surgery. Patients' medical records were reviewed for length of stay, complications, co-morbidities, and weight loss.RESULTS: Five patients were men and 2 were women. Co-morbidities included sleep apnoea syndrome (7 patients [100%]), venous ulcers (4 patients [57.1%]), post-thrombotic venous syndrome (3 patients [42.9%]), symptomatic cholelithiasis (3 patients [42.9%]), cellulites (3 patients [42.9%]), hypertension (4 patients [57.1%]), cardiac insufficiency (3 patients [42.9%]), and diabetes mellitus (1 patient [14.3%]). The length of stay averaged 15.3 days. Three patients presented short-term complications, 2 with long-term complications. Overall weight loss was 42.8% of excess body weight 6 months after surgery and 80.8% 2 years after surgery (when follow-up was completed).CONCLUSIONS: Bariatric operations are safe and effective in the mega-obese population weighing more than 250 kg. Some minor modifications to the traditional techniques may be necessary, especially concerning equipment. Treatment of patients weighing more than 250 kg is problematic, presenting a relatively high percentage of short- and long-term complications, together with various intra-operative problems.