Page 28 - World Journal of Laparoscopic Surgery

ORIGINAL ARTICLE
Short-term Outcomes after Bariatric Surgery during the

COVID-19 Pandemic

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Koel Dutt , Claire Paice , Ciara Caleshu , Arun Ariyarathenam , ML Humphreys , David SY Chan 6
AbstrAct
Background: Elective surgery, especially bariatric surgery, was stopped during the coronavirus disease-2019 (COVID-19) pandemic in the
United Kingdom. Obesity is a major risk factor for COVID-19-related mortality. As the COVID-19 infection and mortality rates in Devon had been
relatively low, bariatric procedures resumed with the necessary precautions in Plymouth with the easing of lockdown restrictions in mid-May.
The aim of this study was to examine the outcome of bariatric surgery during the COVID-19 pandemic.
Methods: Details of 38 patients, who underwent bariatric surgery between June 2020 and November 2020, were analyzed prospectively. All
patients underwent a COVID-19 swab test 24–48 hours prior to the surgery. The primary outcome measure was COVID-19-related morbidity.
Secondary outcomes were non-COVID-19-related morbidity, mortality, and weight loss at 6-week follow-up.
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Results: Thirty-eight patients [24 females; median age 51 (24–63) years, median body mass indices (BMI) at surgery 42.9 (32.4–62.5) kg/m ]
underwent bariatric surgery. Thirty-seven patients were of White British ethnicity. No patient tested positive for COVID-19 pre- and
postoperatively. No patient had any COVID-19-related morbidity or mortality. One patient developed a staple line bleed and returned to theater
for relook laparoscopy and hemostasis. One patient developed an anastomotic leak and had a relook laparotomy for lavage and drain placement.
The median length of hospital stay was 1 day. One patient was preplanned for intensive care admission and he stayed in a high dependency unit
(HDU) for 1 day. All patients were followed up for 6 weeks and the median (range) excess weight loss (%EWL), at 6 weeks, was 24.4% (−0.9–53.6).
Conclusion: Bariatric surgery can be performed safely in an area of low COVID-19 prevalence with the necessary precautions.
Keywords: Bariatric surgery, COVID-19 pandemic, Precautions, Roux-en-Y gastric bypass, Sleeve gastrectomy.
World Journal of Laparoscopic Surgery (2022): 10.5005/jp-journals-10033-1487

IntroductIon 1 Department of Upper GI/Oesophagogastric Surgery, University
The World Health Organization (WHO) declared the coronavirus Hospitals Plymouth, Plymouth, England, United Kingdom
disease-2019 (COVID-19) pandemic on March 11, 2020, with more 2,3 Department of Upper GI/Bariatric Surgery, Derriford Hospital,
than 11 million cases reported worldwide and over 540,000 Plymouth, England, United Kingdom
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deaths. Indeed, most organizations including the International 4–6 Plymouth Oesophago-Gastric Centre, Plymouth, England, United
Federation for the Surgery of Obesity and Metabolic Diseases Kingdom
(IFSO) have recommended postponing all elective and endoscopic Corresponding Author: Koel Dutt, Department of Upper GI/
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procedures related to bariatric surgery. The American College of Oesophagogastric Surgery, University Hospitals Plymouth, Plymouth,
Surgeons has also triaged procedures on the morbidly obese and England, United Kingdom, Phone: +07565246022, e-mail: koel.dutt@
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recommended delaying all elective bariatric procedures. The aim nhs.net
was to minimize risks to the patient and healthcare team and to How to cite this article: Dutt K, Paice C, Caleshu C, et al. Short-term
reduce unnecessary usage of limited resources. The results from Outcomes after Bariatric Surgery during the COVID-19 Pandemic.
a large international study involving over 1,000 patients in 24 World J Lap Surg 2022;15(1):26–30.
countries have documented a significant risk of mortality following Source of support: Nil
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perioperative COVID-19 infection in elective surgical patients.
However, these were stratified neither according to surgical Conflict of interest: None
procedure nor country and local infection rates.
The prevalence of COVID-19 infection varies throughout study was to determine the outcomes of elective bariatric surgery
the United Kingdom. While London and the North West had an during this phase of the COVID-19 pandemic.
infection rate of 40 per 100,000, Devon and Cornwall counties
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in the southwest had less than 20 confirmed cases per 100,000.
Mortality rates at 41 per 100,000 had also remained much lower Methods
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here than most of England (137 per 100,000 in London). Routine As this was a review of current practice, no formal ethical approval
operations at our hospital had ceased with the announcement of was required. Informed consent was obtained from all patients.
national lockdown on March 23, 2020. However, certain urgent Our local review board approved this study.
elective procedures, including cancer and emergency procedures, Details of 38 consecutive patients, who underwent elective
continued with close adherence to the evolving national and local bariatric surgery between June 1, 2020, and November 30,
safety guidelines. Encouraged by the favorable outcomes from 2020, as performed by three bariatric surgeons in a tertiary care
these procedures, bariatric surgery was restarted as the rate of hospital, were analyzed prospectively according to the STROBE
infection decreased and lockdown restrictions eased. The aim of this guidelines. 7

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