Bariatric surgery in patients with previous COVID-19 infection

Abstract

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.

Bariatric Surgery is Safe for Patients After Recovery from COVID-19

“…This study shows that in patients with obesity who have survived COVID19, bariatric surgery is still safe. It is in agreement with a recently published case series including 35 European patients who underwent bariatric surgery after recovery from COVID-19 [ 17 ]. Bariatric surgery should not be considered elective in the setting of this pandemic as patients with obesity are at increased risk of mortality and it can be conducted safely both before and after infection.…”

Is COVID-19 Severity Impacted by Bariatric Surgery in the Early Postoperative Period?

“…In the current scenario of pandemic decline and relaxation of restrictive measures, bariatric surgery centers seem to gradually return to the pre-SARS-CoV-2 status, but there is still no consensus on the safety of the procedure in candidates recovered from COVID-19 [ 17 ]. Nedelcu et al aimed to provide evidence for such questioning through a multicentric cohort in which the authors described the clinical pictures of 35 individuals with severe obesity and documented previous infection by SARS-CoV-2, also analyzing their postoperative complications [ 18 ]. In comparison to the clinical evolution of patients in the preoperative group in our study, participants in that study had considerably fewer symptoms related to COVID-19 (42.9% vs 92.9%).…”

When to perform bariatric surgery after COVID-19 infection

“…In the current letter ( 1 ) the authors reported two cases of patients with previous COVID-19 infection scheduled for bariatric surgery, as a reply to our initial manuscript ( 2 ). They should be commended for inciting bariatric professionals to progress in order to better address the history of COVID and future bariatric surgery, but their letter is lacking important information about these two cases, especially regarding their clinical status and preoperative pulmonary functional tests.…”

“…They have misunderstood our conclusion and completely neglect the term “minor”. Our manuscript ( 2 ) reported 35 patients who underwent different procedures of bariatric surgery after previous COVID-19 infection. We remind the authors that the mean interval time from COVID infection to the bariatric surgery in our manuscript was of 11.3 weeks (3 – 34 weeks) and NOT 4 weeks.…”