Background: Although safe practice guidelines were issued by the Obesity and Metabolic Surgery Society of India (OSSI) in the end of May 2020, surgeons have been in a dilemma about risk of subjecting patients to hospitalisation and bariatric surgery. This survey was conducted with the objective to evaluate the risk of coronavirus disease-19 (COVID-19) infection in peri- and post-operative period after bariatric and metabolic surgery (BMS). Methods: A survey with OSSI members was conducted from 20 July 2020 to 31 August 2020 in accordance with EQUATOR guidelines. Google Form was circulated to all surgeon members through E-mail and WhatsApp™. In the second phase, clinical details were captured from surgeons who reported positive cases. Results: One thousand three hundred and seven BMS were reported from 1 January 2020 to 15 July 2020. Seventy-eight per cent were performed prior to 31 March 2020 and 276 were performed after 1 April 2020. Of these, 13 (0.99%) patients were reported positive for COVID-19 in the post-operative period. All suffered from a mild disease and there was no mortality. Eighty-seven positive cases were reported from patients who underwent BMS prior to 31 December 2019. Of these, 82.7% of patients had mild disease, 13.7% of patients had moderate symptoms and four patients succumbed to COVID-19. Conclusion: BMS may be considered as a safe treatment option for patients suffering from clinically severe obesity during the COVID-19 pandemic. Due care must be taken to protect patients and healthcare workers and all procedures must be conducted in line with the safe practice guidelines.
Introduction: Stomach sleeve obstruction can occur after sleeve gastrectomy (SG). It results in absolute intolerance to liquid and food intake. The obstruction of sleeve may be because of stomach torsion, twisting, kinking, folding, adhesions, and stenosis/narrowing. We present a case report of two patients with absolute intolerance to liquid intake because of sleeve obstruction. The reason for obstruction was folding, twisting, and partial torsion of the stomach sleeve after SG. Case/technique description: Two patients with absolute intolerance to liquid intake were received on day 5 and on day 12 after undergoing primary laparoscopic SG. The endoscopy findings were similar in both the cases. It was not possible to reach pylorus without great difficulty and high level of maneuverability. The laparoscopic findings were twisting and partial torsion due to laxity of the sleeve. Gastropexy was done in both the cases. The recovery in terms of excellent tolerance for liquid intake was immediate and that too without recurrence. Discussion: The distal passage for food and liquid in the lumen of the sleeve should remain very smooth. The lumen can accept arrival of the Ryle's tube or gastric calibration tube up to antrum without any great assistance. This will not be possible in case of improper architecture of the crafted sleeve. The design of the sleeve may be improper from the beginning or it may mutate because of abnormal adhesion at any time during postoperative course. Symptoms and endoscopic findings are diagnostic of the problem. Laparoscopic correction of the architecture of the sleeve by doing adhesiolysis and gastropexy is successful.
Introduction: Stomach sleeve obstruction can occur after sleeve gastrectomy (SG). It results in absolute intolerance to liquid and food intake. The obstruction of sleeve may be because of stomach torsion, twisting, kinking, folding, adhesions, and stenosis/narrowing.We present a case report of two patients with absolute intolerance to liquid intake because of sleeve obstruction. The reason for obstruction was folding, twisting, and partial torsion of the stomach sleeve after SG.
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