Bariatric surgery in patients with previous COVID-19 infection

Nedelcu, Marius; Marx, Ludovic; Lutfi, Rami Edward; Vilallonga, Ramon; Diaconu, Victor; Aboudi, Shadi; De Tudela, Artur Cirera; Ferrer, José Vicente; Ramirez, Jose; Noel, Patrick; Nedelcu, Anamaria; Carandina, Sergio

INTRODUCTION: 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 previous COVID-19 infection and favorable outcome seeking for bariatric surgery. OBJECTIVE: The purpose of the current manuscript is to analyze the risk of specific complications for patients with previous COVID-19 infection who were admitted for bariatric surgery. SETTINGS: 8 high volume private centers from 5 countries METHODS: All patients with morbid obesity disease 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 days) specific complications related to COVID-19 infection, following bariatric surgery and the secondary outcome was to analyze additional work up to prevent them. RESULTS: Thirty-five patients with a mean age of 40 years (range 21 – 68) and mean BMI 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: no symptoms (15 patients), fever and respiratory signs (12 patients), only fever (5 patients), digestive symptoms (2 patients), and isolated respiratory signs (one patient). Only 5 patients (14.2 %) were hospitalized for COVID-19 infection for a mean period of 8.8 days (range 6-15 days). One patient was admitted in intensive care unit and needed invasive mechanical ventilation. The mean interval time from COVID infection to the bariatric surgery was of 11.3 weeks (3 - 34 weeks). Hospital stay was 1.7 days (± 1) and all patients were clinically evaluated one month following the bariatric procedure. There were 2 readmissions and one case of complication: one case of gastric leak treated with laparoscopic drainage and repeated pigtail drain with favorable outcome. No case 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, the previous COVID-19 infection has not induced additional specific complications following bariatric surgery.