The International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO) has issued recommendations to its global healthcare providers aimed at keeping all metabolic and bariatric surgery patients and practice staff in a safe as environment as possible.
The paper, ‘Recommendations for Metabolic and Bariatric Surgery During the COVID-19 Pandemic from IFSO’, was published in Obesity Surgery, and authored by Wah Yang and Cunchuan Wang (The First Affiliated Hospital, Jinan University, Guangzhou, China), Scott Shikora (Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, US and Lilian Kow (Adelaide Bariatric Centre, Flinders Private Hospital, Bedford Park, Adelaide, South Australia, Australia). The recommendation cover general recommendations, screening and diagnosis recommendations, as well as recommendations for emergency surgery for treating postoperative complications. In addition, the paper has recommendations for follow-up and integrated health allied support.
Currently, it is recommended that all elective surgical and endoscopic cases for metabolic and bariatric surgery are postponed minimising the risks to both patient and healthcare team, as well as minimising the potential exposure of the COVID-19 virus to unsuspecting healthcare providers and patients. The postponing of surgery will also reduce the utilisation of unnecessary resources, such as beds, ventilators and personal protective equipment (PPE).
With regards to screening and diagnosis, it is recommended that the body temperature of all patients upon arrival at endoscopy units, clinics or inpatient wards should be checked and documented, with all admissions to hospital screened for COVID-19 by chest computed tomography (CT) scan and be confirmed by real-time reverse-transcriptase polymerase chain reaction (RT-PCR) assay for nasal and pharyngeal swab specimens.
All patients should also asked about recent medical history (ever or respiratory symptoms, family members or close contacts with similar symptoms), as well as any contact with a confirmed case of COVID-19 and recent travel to high-risk areas.
Emergency surgery
Only emergency surgeries for treating severe complications of bariatric surgery are recommended (postoperative bleeding, leak, etc). However, the paper states that differential diagnosis “should be made as similar clinical characteristics such as fever or respiratory symptoms can be present in both COVID-19 patients and patients with postoperative leak, infection or bleeding.” It is recommended that multidisciplinary team should work together in such instances.
In the case of suspected or confirmed COVID-19 cases, emergency surgery can be offered after considering conservative treatment, and the surgery should be performed in negative pressure rooms and isolation precautions should be taken.
Follow-up within clinic and hospitals are not recommended, instead the utilisation of telemedicine, online or phone follow-up should be considered (if possible) to decrease the number of patients in hospital and divert resources to patients who are less willing or unable to travel. Integrated health allied support (nutritional and psychological advice) should be provided during difficult times.
All face-to-face academic activities and conferences should be cancelled or postponed, online and virtual conference will be a good option.
The paper, also highlight the general good hygiene practices to protect against infection and prevent the virus spreading, including:
Covering your coughs and sneezes with your elbow or a tissue
Disposing of tissues properly
Washing your hands often with soap and water, including before and after eating and after going to the toilet
Using alcohol-based hand sanitisers
Cleaning and disinfecting surfaces
If you are sick, avoiding contact with others and staying more than 1.5 m away from people
Cleaning and sanitising frequently used objects such as mobiles, keys and wallets
“IFSO has an obligation to help contain and mitigate the effects of the pandemic on the 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,” the paper concluded. “We plan to work together and provide updates as appropriate.”
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