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‘Returning to surgery’ – the views of bariatric and metabolic experts

Tue, 08/04/2020 - 00:08
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As bariatric and metabolic surgery restarts across the world, Bariatric News spoke to current IFSO President, Lilian Kow about how the bariatric community can safely resume surgery... 

1. As the current president of IFSO, what steps has the Federation taken to help promote the safe return to surgery for patients and bariatric specialists?

IFSO has an obligation to help contain and mitigate the effects of the pandemic on the our global scientific, surgical and integrated health communities and protect the health of all IFSO members and their families and all those associated with our members at work, at home and in the community. As a consequence, IFSO has undertaken writing up the guidelines on the safe return to surgery for patients and bariatric surgeons.

Lilian Kow
Lilian Kow

In addition, IFSO ran a series of Webinars in March, April and May on various aspects of COVID-19 to reach out to members to take all possible measures to provide the safest possible environment for themselves and their loved ones. The topics we discussed included : what to expect from this pandemic, managing COVID-19  patients presenting with emergencies within your bariatric practice and the management options within different disciplines, risks of laparoscopy vs laparotomy in a COVID 19 patient: what is the evidence?, enhancing bariatric patient experience during COVID 19, restarting bariatric practice with the COVID-10 pandemic and maintaining skills and training through COVID19 pandemic.

2. IFSO recently endorsed a publication, 'How are We Going to Restart Elective Bariatric and Metabolic Surgery after the Peak of Covid-19Pandemic?’ In the paper, one of the recommendations was 'Priority is for patients who would benefit most from a B&M procedure with limited risk', what is the protocol for defining 'patients who would benefit most from a B&M procedure with limited risk?

In this publication we discussed restarting bariatric surgery for what would be considered the simple straightforward cases. The difficult complicated (patients with co-morbidities, revisional, etc.) cases may require longer hospital stay and possible ICU admission and should be avoided at this time as hospitals are recovering from the pandemic. These “limited risk” group of patients include:

  • Asymptomatic patients (no flu-like symptoms, shortness of breath, fever, and/or GI symptoms).
  • No history of COVID-19 positivity
  • Age: 20 — 50 years
  • BMI ≤ 50 kg/m2
  • No Co-morbidities: (i.e. Diabetes, Hypertension, Cardiac diseases)
  • No Pulmonary diseases: (i.e. OSA, Asthma, Respiratory diseases)
  • Non-smokers

3. Obesity is a known major risk factor for dying of COVID-19, will IFSO be renewing its efforts to encourage governments and insurance companies around the world to invest more in obesity treatments, and specifically, bariatric and metabolic surgery?

This is a very important point. The history of previous pandemics of different viral influenza-like illnesses revealed a strong association between morbid obesity and the severity of the illness and hospital and ICU admissions  Additionally, it has been reported anecdotally by a number of surgeons that patients who have had successful bariatric surgery that resulted in significant weight loss and the resolution of co-morbid conditions such as hypertension and diabetes, have been able to overcome the COVID-19 disease and its pulmonary complications. The current evidence from COVID-19 so far suggests a similar association that obesity is associated with a higher risk of developing severe symptoms and complications of COVID-19, independent of other illnesses, such as cardiovascular disease.

IFSO’s mission is to optimise the control of adiposity-based chronic disease. As such IFSO has an obligation to reach out to all health care providers, stakeholders, governments and insurance companies around the world to help fight the fight against obesity and to help contain and mitigate the effects of the pandemic on the obese population.

The 'Return to work' survey and interviews with bariatric and metabolic specialists were carried out in partnership with Medtronic Inc.