Bariatric Surgical Practice During the Initial Phase of COVID-19 Outbreak

Abstract

There is no data on patients with severe obesity who developed coronavirus disease 2019 (COVID-19) after bariatric surgery. Four gastric bypass operations, performed in a 2-week period between Feb 24 and March 4, 2020, in Tehran, Iran, were complicated with COVID-19. The mean age and body mass index were 46 ± 12 years and 49 ± 3 kg/m². Patients developed their symptoms (fever, cough, dyspnea, and fatigue) 1, 2, 4, and 14 days after surgery. One patient had unnoticed anosmia 2 days before surgery. Three patients were readmitted in hospital. All 4 patients were treated with hydroxychloroquine. In two patients who required admission in intensive care unit, other off-label therapies including antiretroviral and immunosuppressive agents were also administered. All patients survived. In conclusion, COVID-19 can complicate the postoperative course of patients after bariatric surgery. Correct diagnosis and management in the postoperative setting would be challenging. Timing of infection after surgery in our series would raise the possibility of hospital transmission of COVID-19: from asymptomatic patients at the time of bariatric surgery to the healthcare workers versus acquiring the COVID-19 infection by non-infected patients in the perioperative period.

Keywords: Bariatric surgery; COVID-19; Complications; Coronavirus; Gastric bypass; Pneumonia.

Fig. 1

Chest CT scan of COVID-19 pneumonia after bariatric surgery. a Patient 3: Bilateral large areas of ground-glass opacities and consolidations, giving a crazy paving pattern and a white lung appearance, 4 days after gastric bypass. b Patient 4: Multiple bilateral peripheral ground-glass opacities 2 days after gastric bypass