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.

Background: The global COVID-19 pandemic has resulted in the widespread suspension of bariatric surgical programs. Although this rapid adaption was initially necessary, the implications of delaying the most effective treatment for weight loss in a population at risk from this crisis are not well known. Moreover, as the health care trusts plan the reintroduction of elective services, it is vital to also consider the patient’s perspectives, to adequately weigh up the benefits and risks of this recommencement in the current climate. Objectives: We aimed to investigate the impacts that postponing bariatric surgery has had on patients, and their priorities when restarting elective surgery. Methods: An online survey of patients awaiting surgery was undertaken, examining the physical and psychological impacts of pandemic isolation policies and postponing surgery, and exploring patient preferences regarding surgery during the pandemic. Results: Of 71 patients, 67.6% gained a median of 4 kg (interquartile range: 2.6-6.4), and 74.6% had adverse psychological effects; 93.0% were keen to proceed with surgery. Thematic analysis of qualitative data revealed delays have worsened physical symptoms, increased anxiety, and delayed secondary life-altering treatments. Conclusion: From the patient’s perspective, postponing surgery has been deleterious and efforts to safely reintroduce bariatric programs should be promoted.

Aim Oesophageal perforation is a relatively rare surgical condition associated with a high mortality risk. Currently there is no clear consensus on a superior approach to treating this condition, and the rarity of oesophageal perforation has led to a great variability in treatment between centres. This study aims to report the experiences of a tertiary referral centre over 12 years. Methods We collected data on patients presenting with oesophageal perforation at a tertiary referral centre from 2009–2021 (n=83). Demographics, presenting symptoms, length of stay and complications were collected retrospectively using the electronic patient record. Results The most common cause of perforation in our dataset was Boerhaave's (50.6%), followed by Iatrogenic (37.4%); other causes included trauma, malignancy and foreign body ingestion. Typical signs/symptoms included chest pain (54.2%), vomiting (48.2%), and pleural effusion (42.2%). For all aetiologies, operative intervention was required in 49.4% of patients. Patients presenting with Boerhaave's were more likely to be treated surgically (73.8%). Of these, thoracotomy/laparotomy with t-tube repair was the most common procedure performed (59.5%). The 30 day and 90 day mortality rates were 16.9% and 21.6% respectively. The median length of hospital stay was 40 days. Conclusion Here we show the experience from a high intake tertiary referral centre over 12 years. Our data confirms the severity of oesophageal perforation and its association with prolonged hospital stay and mortality. Further collaboration with other centres is needed to understand more about this condition.

Aim Oesophageal perforation is a rare surgical condition with high mortality. Boerhaave's syndrome (BS) may be associated with worse outcomes due to the degree of mediastinal contamination when compared to ‘clean’ iatrogenic perforations. This study aims to assess the differences in treatment and outcome between these two groups. Methods Data was collected from a tertiary centre from 2009–2021 (n=73, 42 BS, 31 Iatrogenic). Data was collected retrospectively using the electronic patient record. Complications were quantified using the comprehensive complication index (CCI). Univariate analysis was used to determine statistical significance. Results BS had a higher 30-day mortality compared to iatrogenic perforations (21.4% vs 3.2% p=0.025), however this was no longer significant at 90 days and 1 year (21.4% vs 16.1% p=0.57, 21.4% vs 19.4% p=0.83). Iatrogenic perforations were more likely to be managed non-operatively (73.8% vs 25.8% p<0.001). All of the iatrogenic deaths that occurred between 30 days-1 year had been managed non-operatively. Median length of intensive care stay was higher in BS (15 days vs 6 days p=0.047), with no significant difference in median overall length of stay (48 days BS vs 38 days iatrogenic p=0.88). Median CCI was greater in BS (53.9 vs 29.6 p=0.002). Conclusion Whilst CCI and 30-day mortality was higher in Boerhaave's there was no difference in 90-day and 1 year mortality suggesting that long-term survival is not dictated by aetiology of the perforation. Most of the iatrogenic perforation were managed non-operatively which raises the question whether iatrogenic perforation should be managed more aggressively.