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.

fost investigat prin endoscopie digestivă superioară, diagnosticul de HH fiind stabilit pentru 339 pacienţi (48,78%). În toate aceste cazuri, HH a fost reparată simultan cu efectuarea gastrectomiei longitudinale laparoscopice. Preoperator diagnosticul de HH a fost stabilit pentru 192 pacienţi [(56,63%)-grup A]. Folosind protocolul pentru identificarea activă a herniei hiatale nediagnosticate preoperator-SPAIH, HH a fost descoperită intraoperator pentru 147 de pacienţi (43,37%)-grup B. Concluzii: diagnosticarea HH prin endoscopia digestivă superioară şi studiu radiologic esogastroduodenal cu bariu este suboptimală şi, prin urmare, pentru un număr semnificativ de pacienţi, HH a fost descoperită intraoperator, folosind protocolul chirurgical-SPAIH. Recalibrarea hiatusului esofagian concomitent cu gastrectomia longitudinală laparoscopică reprezintă o tehnică reproductibilă, care ar putea preveni postoperator progresia HH şi limitarea posibilelor complicaţii evolutive ale bolii de reflux gastroesofagian.

(1) to identify gastroesophageal reflux condition or complications in patients undergoing metabolic surgery. (2) Study the correlations of the clinical symptoms of GERD with the preoperative radiological and endoscopic findings. All the consecutive patients (GERD symptomatic or not) undergoing metabolic surgery in a Bariatric Center of Excellence between December, 2015 and May 2016 were included in a prospective study. A multidisciplinary team evaluated all the patients within the bariatric surgery program. Clinical evaluation, radiological and endoscopic investigations were performed to all the included patients. The patients who previously had anti-reflux or bariatric surgery were excluded. Four-hundred-forty-eight consecutive patients were enrolled into the study. The mean age of patients was 41.04 (+-11.15) years, and 29% of them were men. The mean BMI was 39.96 (+-8.17) kg/m2. Symptoms of GERD were recorded only in 93 of the patients (20.76%) while endoscopic examination revealed esophagitis in 139 (31,03%) patients (107 Grade A, 28 Grade B, 3 Grade C, 1 Grade D. Barrett esophagus was suspected in 5 patients but histologic confirmation (gastric metaplasia) was recorded only in 2 patients (0.44%). Hiatal hernia was revealed by endoscopy and radiology in 119 (26,56%) and 112 patients (25%). 62% of the patients presenting esophagitis (86/139) had no pre-operative symptom of GERD, meaning that a significant number of the asymptomatic patients undergoing metabolic surgery may present consequences of gastro-esophageal reflux. The study demonstrates that GERD is more frequent then expected in asymptomatic obese patients undergoing metabolic surgery. The clinical impact of these findings is important for the proper procedure selection and for a correct evaluation of the postoperative evolution.

Introducere: Gastrectomia longitudinala laparoscopică este o procedură bariatrică larg aplicată cu rezultate bune privind scăderea ponderală şi remisia comorbidităţilor. Pentru pacienţii cu recâştig ponderal şi lărgirea tubului gastric, gastrectomia longitudinală iterativă poate fi opţiunea revizională. Scop: Studiul îşi propune evaluarea rezultatelor gastrectomiei longitudinale ca procedură revizională după gastrectomia longitudinală iniţială într-un centru de excelenţă în chirurgie bariatrică. Metodă: Studiul a presupus o evaluare retrospectivă a bazei de date instituţionale menţinută prospectiv, identificând 27 de pacienţi operaţi în clinica noastră cu gastrectomie longitudinală laparoscopică (re-sleeve) după gastrectomie longitudinală (gastric sleeve) iniţială, în perioada ianuarie 2013-decembrie 2016. Pacienţii au fost urmăriţi în conformitate cu programul nostru bariatric standardizat, iar eficienţa rezecţiei iterative, privind scăderea ponderală şi remisia comorbidităţilor, au fost evaluate la 6 luni, 1 an şi 3 ani postoperator. Rezultate: Gastrectomia longitudinală iterativă a fost realizată pe cale laparoscopică în toate cazurile, iar 24 de pacienţi (89%) au avut procedee chirurgicale asociate, la toţi aceştia a fost tratată hernia hiatală. Nu au existat complicaţii intra-sau postoperatorii cu excepţia unui caz de stenoză a tubului gastric. Indicele de masă corporală, BMI, înainte de re-sleeve a fost în medie 35,69 kg/m 2 (limite 28,58-52). Urmărirea la 6 luni după re-sleeve a arătat BMI