key: cord-0014966-nc6nfg8o
authors: Sterkers, A.; Blanchet, M.-C.; Genser, L.; Rebibo, L.; Kassir, R.; Pattou, F.; Msika, S.
title: Obesity surgery and COVID-19 pandemic: What is the suitable attitude to adopt?
date: 2020-12-05
journal: J Visc Surg
DOI: 10.1016/j.jviscsurg.2020.12.002
sha: 4bdfe31de761e54cd27501307938a12e0d658c94
doc_id: 14966
cord_uid: nc6nfg8o

nan

The COVID-19 epidemic is now highlighted by a new wave of contamination that once again places our health care system under severe stress. In some French regions, human and material resources are organised in a way that prioritises treatment and management of infected patients. While the strength and duration of the second wave remain unknown, its arrival most certainly necessitates reorganisation of the care offered in the framework of bariatric and metabolic surgery.

As was the case during the first wave, population movements have had to be restricted, and consultations must be carried out to the greatest possible extent by telemedicine.

Bariatric procedures should once again be accorded priority. As was the case during the first wave, and whatever may be the phase of pandemic alerts, bariatric emergencies and semi-emergencies must necessarily remain high on the surgeon's working agenda.

It is essential to avoid considering programmed operations in bariatric and metabolic surgery as merely functional surgery; on this issue, the SOFFCO-MM fully concurs with the American Society of Metabolic and Bariatric Surgery [1] . Several arguments may be raised in favour of conserving surgical activity throughout the second wave. Firstly, as is the case with surgical treatment of some cancers, bariatric surgery has been demonstrably effective in prolonging life expectancy [2, 3] . Secondly, reduction following surgery of some of the comorbidities associated with obesity concomitantly minimises the impact of COVID-19 infection [4, 5] , especially insofar as obese patients are considered as a vulnerable population [6] . Thirdly, facilitated access to screening tests since this past summer has rendered the operating theatre safer than previously.

However, in most establishments, the existing human and material resources do not suffice to fully ensure routine care, and prioritising is called for. The order of priority instituted in activity resumption when lockdown measures are lifted can also be applied during the second wave of the epidemic. Patients with severe and/or multiple comorbidities should be prioritised. It is essential, as when lockdown is eased, to envision few procedures other than those presenting a low risk of complication. Last spring, the SOFFCO-MM drew up recommendations aimed at helping practitioners to prioritise patients according to the local health-care context (Fig. 1) [7] . This document is meant to be of practical assistance. It will be up to RCP (multidisciplinary meeting) participants to decide on a case-by-case basis on the most suitable type of care, while taking into full account the regional setting.

The authors declare that they have no competing interest.

Safer through surgery: American Society for Metabolic and Bariatric Surgery statement regarding metabolic and bariatric surgery during the COVID-19 pandemic

Life expectancy after bariatric surgery in the Swedish obese subjects study

Radical prostatectomy or watchful waiting in prostate cancer -29-year follow-up

COVID-19 and its severity in bariatric surgery operated patients. Obesity (Silver Spring) 2020 [Epub ahead of print

High prevalence of obesity in severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) requiring invasive mechanical ventilation. Obesity (Silver Spring) 2020

SOFFCO-MM guidelines for the resumption of bariatric and metabolic surgery during and after the Covid-19 pandemic