COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery

Behrens, Estuardo; Poggi, Luis; Aparicio, Sergio; Duartez, Pedro Martínez; Rodríguez, Nelson; Zundel, Natán; Cardoso, Almino Ramos; Camacho, Diego; Lopez-Corvala, Juan A.; Vilas-Bôas, Marcos Leão; Laynez, Jorge

doi:10.1007/s11695-020-04910-9

Cited by 8 publications

(18 citation statements)

References 44 publications

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“…Considering the increased risks for severe forms of COVID-19 infection that obesity engenders and the protective role of bariatric surgery in avoiding invasive mechanical ventilation and death, the pressure to return to normal activity for bariatric surgery was important. The resumption of bariatric surgery following the first peak of COVID-19 infections was controlled by several guidelines [ 8 , 16 , 17 , 18 ]. All these recommendations focused on the preoperative work-up for bariatric surgery and COVID-19 and on perioperative measures to avoid contamination.…”

Section: Discussionmentioning

confidence: 99%

Bariatric surgery in patients with previous COVID-19 infection

Nedelcu

Marx²,

Lutfi³

et al. 2021

Surgery for Obesity and Related Diseases

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Background The process of reintroducing bariatric surgery to our communities in a COVID-19 environment was particular to each country. Furthermore, no clear recommendation was made for patients with a previous COVID-19 infection and a favorable outcome who were seeking bariatric surgery. Objectives To analyze the risks of specific complications for patients with previous COVID-19 infection who were admitted for bariatric surgery. Setting Eight high-volume private centers from 5 countries. Methods All patients with morbid obesity and previous COVID-19 infection admitted for bariatric surgery were included in the current study. Patients were enrolled from 8 centers and 5 countries, and their electronic health data were reviewed retrospectively. The primary outcome was to identify early (<30 d) specific complications related to COVID-19 infection following bariatric surgery, and the secondary outcome was to analyze additional factors from work-ups that could prevent complications. Results Thirty-five patients with a mean age of 40 years (range, 21–68 yr) and a mean body mass index of 44.3 kg/m 2 (±7.4 kg/m 2 ) with previous COVID-19 infection underwent different bariatric procedures: 23 cases of sleeve (65.7 %), 7 cases of bypass, and 5 other cases. The symptomatology of the previous COVID-19 infection varied: 15 patients had no symptoms, 12 had fever and respiratory signs, 5 had only fever, 2 had digestive symptoms, and 1 had isolated respiratory signs. Only 5 patients (14.2 %) were hospitalized for COVID-19 infection, for a mean period of 8.8 days (range, 6–15 d). One patient was admitted to an intensive care unit and needed invasive mechanical ventilation. The mean interval time from COVID-19 infection to bariatric surgery was 11.3 weeks (3–34 wk). The mean hospital stay was 1.7 days (±1 d), and all patients were clinically evaluated 1 month following the bariatric procedure. There were 2 readmissions and 1 case of complication: that case was of a gastric leak treated with laparoscopic drainage and a repeated pigtail drain, with a favorable outcome. No cases of other specific complications or mortality were recorded. Conclusion Minor and moderate COVID-19 infections, especially the forms not complicated with invasive mechanical ventilation, should not preclude the indication for bariatric surgery. In our experience, a prior COVID-19 infection does not induce additional specific complications following bariatric surgery.

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Section: Discussionmentioning

confidence: 99%

Bariatric surgery in patients with previous COVID-19 infection

Nedelcu

Marx²,

Lutfi³

et al. 2021

Surgery for Obesity and Related Diseases

View full text Add to dashboard Cite

show abstract

“…Prior to conducting this study, the researchers took into account the recommendations issued by different professional groups such as the IFSO and ASMBS [5][6][7]26]. These groups considered BMS essential, and therefore the safety goals were met and adequate triage was performed to identify patients with potential SARS-CoV-2 infection.…”

Section: Methodsmentioning

confidence: 99%

“…The evolution and impact of the COVID-19 pandemic varies greatly from country to country [5]. SARS-CoV-2 will probably circulate in the population for a long time, and the return to normal services, including surgery, will be gradual.…”

Section: Introductionmentioning

confidence: 99%

“…However, a delay of months or years in life-saving survival treatment of obesity and its repercussions is not in the best interest of our patients, and the risk and degree of harm from delaying BMS would vary based on each patient's condition. An early resumption of elective BMS could improve metabolic and immunological conditions in these patients, putting them at lower risk of developing serious complications from COVID-19 and probably reducing that risk to the same level as the general population [2,5,6]. While we stress the importance of resuming BMS, we acknowledge it is important to gain a thorough understanding of the limitations of resources in every country, city, and hospital in order to wisely select screening and diagnostic tests suitable for candidates for BMS.…”

Section: Introductionmentioning

confidence: 99%

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Chest Computed Tomography for SARS-CoV-2 Screening before Bariatric and Metabolic Surgery during the COVID-19 Pandemic

Ortiz-Gomez

Guerrero-Gutiérrez

Cardoso

et al. 2020

Preprint

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Introduction: Given that obesity is a risk factor for adverse outcomes in COVID-19, bariatric and metabolic surgery (BMS) has become increasingly critical. Computed tomography (chest CT scan) may be a valuable preoperative screening method for BMS candidates during this COVID-19 pandemic.Methods: A prospective, single-center study was conducted in June 2020. Two study cohorts were evaluated: a surgical team group and a BMS patient group. Screening was performed with RT-PCR and a CT scan. The COVID-19 Reporting and Data System (CO-RADS) assessment was used as mandatory COVID-19 screening. Patients classified as category 1 and 2 were considered safe to undergo BMS; category ≥3 surgery was canceled. The BMS patient group was monitored for 28 days after surgery for SARS-CoV-2 infection. Additionally, postoperative complications, adverse effects, and deaths were tracked.Results: The study included 240 participants, comprising the surgical team group (n = 6) and the BMS patient group (n = 234). In total, 213 were female (88.8%), the median age was 40 years, and the median weight and BMI were 111.1 kg and 40.23 kg/m2 respectively. Only CO-RADS category 1 was reported in the surgical team group, while in the BMS patient group, category 1 was reported in 231 participants (98.7%). In the BMS patient group, during the follow-up period, only two participants (0.83%) tested positive for COVID-19 (RT-PCR). No deaths were reported. Conclusion: Chest CT scans are useful for detecting SARS-CoV-2 in patients undergoing BMS, therefore enable healthcare and surgical teams to perform surgeries safely during this COVID-19 pandemic.

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“…The implications of these widespread suspensions of the most effective treatment for weight loss in patients with a higher risk of severe COVID-19 complications are still unknown. Surgical scientific societies have developed guidelines to safely resume bariatric surgery which along with institutional strict perioperative COVID-19 protocols allowed the start of surgical procedures [ 10 – 12 ].…”

Section: Introductionmentioning

confidence: 99%

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

et al. 2021

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Introduction Increased morbimortality in patients with COVID-19 infection who had undergone surgery has raised concerns about bariatric surgery safety during the current COVID-19 pandemic. Currently, there is scarce literature on safety outcomes after bariatric surgery during the COVID-19 pandemic. Objectives To determine the risk of symptomatic COVID-19 infection and associated complications during the first 30 days after bariatric surgery. Materials and Methods Prospective observational cohort study including all patients who consecutively underwent primary bariatric surgery between August and December 2020. Results A total of 189 patients were included. Median age and BMI were 36 (17–70) years and 38 (35–41) kg/m 2 , respectively. Forty percent of patients were women ( n = 76), 59.3% ( n = 112) underwent sleeve gastrectomy (SG), and 40.7% ( n = 77) underwent Roux-en-Y gastric bypass (RYGB). All surgeries were performed laparoscopically. The median length of postoperative stay was 2 (0–5) days. Postoperative COVID-19 infection was detected in two patients (1.1%): one patient was readmitted without the need of intermediate or ICU care, and the other was managed as an outpatient. Major complications occurred in three patients (1.6%); none of them was COVID-19 related. Two patients required an unplanned reoperation. No patient required intermediate or ICU care, no severe COVID-19 complications were observed, and no mortality was reported. Conclusion Bariatric surgery can be safely performed during the ongoing pandemic, albeit a low risk of COVID-19 symptomatic infection. Rigorous perioperative COVID-19 institutional protocols are required to perform bariatric surgery safely during the current pandemic. Graphical abstract

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COVID-19: IFSO LAC Recommendations for the Resumption of Elective Bariatric Surgery

Cited by 8 publications

References 44 publications

Bariatric surgery in patients with previous COVID-19 infection

Bariatric surgery in patients with previous COVID-19 infection

Chest Computed Tomography for SARS-CoV-2 Screening before Bariatric and Metabolic Surgery during the COVID-19 Pandemic

Safety of Bariatric Surgery During the Opening Phase After the First Wave of the COVID-19 Pandemic: Experience at an Academic Center

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