Background There are data on the safety of cancer surgery and the efficacy of preventive strategies on the prevention of postoperative symptomatic COVID-19 in these patients. But there is little such data for any elective surgery. The main objectives of this study were to examine the safety of bariatric surgery (BS) during the coronavirus disease 2019 (COVID-19) pandemic and to determine the efficacy of perioperative COVID-19 protective strategies on postoperative symptomatic COVID-19 rates. Methods We conducted an international cohort study to determine all-cause and COVID-19-specific 30-day morbidity and mortality of BS performed between 01/05/2020 and 31/10/2020. Results Four hundred ninety-nine surgeons from 185 centres in 42 countries provided data on 7704 patients. Elective primary BS (n = 7084) was associated with a 30-day morbidity of 6.76% (n = 479) and a 30-day mortality of 0.14% (n = 10). Emergency BS, revisional BS, insulin-treated type 2 diabetes, and untreated obstructive sleep apnoea were associated with increased complications on multivariable analysis. Forty-three patients developed symptomatic COVID-19 postoperatively, with a higher risk in non-whites. Preoperative self-isolation, preoperative testing for SARS-CoV-2, and surgery in institutions not concurrently treating COVID-19 patients did not reduce the incidence of postoperative COVID-19. Postoperative symptomatic COVID-19 was more likely if the surgery was performed during a COVID-19 peak in that country. Conclusions BS can be performed safely during the COVID-19 pandemic with appropriate perioperative protocols. There was no relationship between preoperative testing for COVID-19 and self-isolation with symptomatic postoperative COVID-19. The risk of postoperative COVID-19 risk was greater in non-whites or if BS was performed during a local peak.

Summary Background Metabolic and bariatric surgery (MBS) is an effective treatment for adolescents with severe obesity. Objectives This study examined the safety of MBS in adolescents during the coronavirus disease 2019 (COVID‐19) pandemic. Methods This was a global, multicentre and observational cohort study of MBS performed between May 01, 2020, and October 10,2020, in 68 centres from 24 countries. Data collection included in‐hospital and 30‐day COVID‐19 and surgery‐specific morbidity/mortality. Results One hundred and seventy adolescent patients (mean age: 17.75 ± 1.30 years), mostly females (n = 122, 71.8%), underwent MBS during the study period. The mean pre‐operative weight and body mass index were 122.16 ± 15.92 kg and 43.7 ± 7.11 kg/m2, respectively. Although majority of patients had pre‐operative testing for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) (n = 146; 85.9%), only 42.4% (n = 72) of the patients were asked to self‐isolate pre‐operatively. Two patients developed symptomatic SARS‐CoV‐2 infection post‐operatively (1.2%). The overall complication rate was 5.3% (n = 9). There was no mortality in this cohort. Conclusions MBS in adolescents with obesity is safe during the COVID‐19 pandemic when performed within the context of local precautionary procedures (such as pre‐operative testing). The 30‐day morbidity rates were similar to those reported pre‐pandemic. These data will help facilitate the safe re‐introduction of MBS services for this group of patients.

Objective Bariatric surgery is a widely used procedure for the treatment of obesity. Our aim is to describe the main immunological changes in patients who undergo bariatric surgery. Methods A prospective study was conducted within a cohort of patients undergoing bariatric surgery and without previous evidence of systemic or organ-specific autoimmune diseases in whom 3 blood samples were collected – one day before surgery (Time 0), and 5 (Time 1) and 10 months (Time 2) after surgery. Results Thirty four obese patients underwent surgery (Time 0):30(88.24%) were women, mean age 38.3 years. When comparing Time 0 and Time 2, there were statistically significant changes in CD4+T cell count, with an increase from 1074/mL(IQR:860–1316) to 1217.5/mL(IQR:838–1510), p = 0.0002. The CD4/CD8 ratio increased from 2.2(IQR: 1.7–2.7) to 2.4(1.8–2.8), p = 0.0001. As for humoral variables, the C3 fraction of complement decreased from 164 ± 40.6 mg/dL to 112.4 ± 31.4 mg/dL( p < 0.001) and C4 decreased from 29.3 ± 10.1 mg/dL to 22.5 ± 7.1( p = 0.0009) at Time 2. Four patients with negative ANAs at baseline, showed positive ANAs at Time 2.One patient developed anti-citrullinated peptide antibodies >200 IU/mL at Time 2. Conclusions Patients undergoing bariatric surgery show immunological changes which might eventually lead to develop an autoimmune disease.

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Introduction: Obesity-related diseases (ORD) are associated with a decrease in the quality of life and life expectancy of patients. The remission of these pathologies after bariatric surgery is not the same in all patients. Objectives: To evaluate the remission of the principal ORD in patients who underwent bariatric surgery. Materials and methods: Retrospective analysis of patients with morbid obesity and ORD (hypertension, diabetes mellitus, dyslipidemia or obstructive sleep apnea and hypoapnea syndrome) who received bariatric surgery between January 2014 and January 2016. Patients had two surgical options: Laparoscopic sleeve gastrectomy (LSG) or laparoscopic Roux-en-Y gastric bypass (LRYGB). Follow-up was performed after 1, 6, and 12 months per the first year after surgery, recording data, such as percentage of excess weight lost (%EWL), percentage of total body weight lost, and partial or total ORD remission. Results: Out of a total of 23 patients, 52% (12) were females and the average age was 44 ± 13 years, 17 (74%) received LSG and 6 (26%) LRYGB. The average initial body mass index was 43 ± 4.3 kg/m², the %EWL at 1, 6, and 12 months was 35.4 ± 15.2, 62.5 ± 17.5, and 79.1 ± 20.2 respectively. Comorbidities remission was found in 95.6% of patients (22), partial resolution in 32%, and complete in 68%. A total of 52.1% of remissions were reported in the first month postsurgery. Conclusion: Bariatric surgery has proved to be the most effective method for reducing and sustaining weight loss in the long-term and comorbidities remission. A decrease of 50% of EWL has a positive impact in terms of discontinuing medications and normalizing the patient's biochemical profile.