Bariatric Surgery during Covid-19 Pandemic

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Bariatric Surgery in Bangalore | Cancer and Bariatric Surgeon

On March 11, 2020, the World Health Organization (WHO) declared the COVID-19 a global pandemic.

Bariatric patients are unique from other surgical patients. Most of them suffer from medical issues such as cardiovascular diseases, hypertension, diabetes, and certain respiratory diseases including OSA. Hence the outbreak of the COVID-19 has drastically changed the way Bariatric surgeons work.

Are Bariatric surgeries safe during this pandemic?

COVID-19, caused by the SARS-CoV-2, is currently believed to spread through respiratory droplets. Currently, antivirals for treatment and vaccines do not exist. Hence it is left to the health care professionals to protect vulnerable patients.

Studies have demonstrated that patients with obesity-related issues such as hypertension, diabetes, cardiovascular and respiratory system disease were the most severely affected among the COVID-19–positive patients. Obesity led to higher complications in patients with COVID-19. Bariatric surgery is essentially a planned elective surgery, and laparoscopic surgery is the most common approach used.

Risks to be aware of in Laparoscopic Surgery:

  1. Particles in surgical smoke have been demonstrated to contain toxic and virulent materials that could potentially infect those who inhale them.
  2. Risk of Aerosol and fomite transmission of the COVID-19 virus is hypothesized
  3. Laparoscopic surgery needs to be conducted with caution because of a higher concentration of particulate matter due to aersolisation.
https://youtu.be/9g-IGnyLvY4
Benefits of Laparoscopic Antireflux Surgery over Traditional Anireflux Surgery

The Current Scenario

Due to the risk of transmission, all non-essential surgeries are postponed until safety can be achieved, both to the patient and surgical staff.  Until there is enough data to verify that surgical exposure is safe, restraint is recommended.

In patients who are COVID-19 positive, unless they have a life-threatening emergency, we recommend delay of surgery until recovered. For patients with unknown COVID-19 status, it is recommended they be tested before surgery.

Best Way Forward

Till such time there is more information about the virus; specific ways can keep the patients at ease. Communication must be balanced, utilizing telehealth technology. It is one productive way to follow up patients postoperatively and also keep those whose surgeries were postponed to maintain a good lifestyle in the time being. This avoids anxiety and panic.

Emergent bariatric procedures

If the situation arises that a bariatric patient needs to be taken for an emergent surgical and the patient has tested positive or is still waiting for COVID-19 test reports, certain precautions should be considered.

  • Every single health care member should wear appropriate PPE gear
  • If it is laparoscopy, ultra-filtration should be used.
  • The surgery should be carried out in a properly ventilated room with all precautions

Conclusion

We recommend that elective Bariatric Surgery in Bangalore be postponed until the COVID-19 pandemic is over. Postoperative follow-up can be done through telemedicine. Patients in the pipeline can be counseled and advised remotely to ensure continued weight maintenance.

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