Bariatric and metabolic surgery during and after the COVID-19 pandemic
Authors: Vasileios Charalampakis, Basil J Ammori, Varadarajan Baskar, Martin Richardson, Rishi Singhal
Journal: The Lancet Diabetes & Endocrinology (2020)

We read the article by Francesco Rubino and colleagues with interest.1Rubino F Cohen RV Mingrone G et al.Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery.Lancet Diabetes Endocrinol. 2020; 8: 640-648Summary Full Text Full Text PDF PubMed Scopus (129) Google Scholar It represents the recommendations of 23 authors on a diverse range of topics around bariatric and metabolic surgery during and after the COVID-19 pandemic, the collation of which is a difficult task. The methodology used to reach this consensus of opinion and recommendations needs to be detailed; we did not come across the use of any established instruments for this exercise, such as the Delphi or modified Delphi approach.2RAND CorporationDelphi method.https://www.rand.org/topics/delphi-method.htmlDate accessed: June 24, 2020Google Scholar The authors very correctly highlight that the remission rate of type 2 diabetes with surgery is higher for patients with shorter diabetes duration.1Rubino F Cohen RV Mingrone G et al.Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgery.Lancet Diabetes Endocrinol. 2020; 8: 640-648Summary Full Text Full Text PDF PubMed Scopus (129) Google Scholar The overarching theme in these recommendations is about prioritising patients who are likely to benefit the most and where delays would be more likely put patients into a more disadvantageous category. We therefore find the authors' recommendation to prioritise patients with diabetes of more than 5 years' duration puzzling and is in direct contradiction to their priority statements. We would also like to draw the readers' attention to a recent publication by Luigi Angrisani and colleagues,3Angrisani L Khidir N Prager G et al.How are we going to restart elective bariatric and metabolic surgery after the peak of Covid-19 pandemic?.Surg Res Rep. 2020; 3: 1-5Google Scholar which took a different view from Rubino and colleagues. This article was co-authored by the president of International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO), along with the president-elect and at least seven other current or past presidents of IFSO chapters. Angrisani and colleagues state that patients with higher BMI and multiple comorbidities (with uncontrolled type 2 diabetes being one of the main areas of concern) are at risk of life-threatening COVID-19-related complications in the perioperative setting, thus concluding that surgery should be offered to patients who are more likely to recover from a possible infection.3Angrisani L Khidir N Prager G et al.How are we going to restart elective bariatric and metabolic surgery after the peak of Covid-19 pandemic?.Surg Res Rep. 2020; 3: 1-5Google Scholar The eligibility criteria for surgery proposed by Angrisani and colleagues included, among others, BMI below 50 kg/m2 and no or controlled comorbidities.3Angrisani L Khidir N Prager G et al.How are we going to restart elective bariatric and metabolic surgery after the peak of Covid-19 pandemic?.Surg Res Rep. 2020; 3: 1-5Google Scholar Considering that obesity is a major risk factor for severe COVID-19 and its related mortality, obesity treatment could offer an opportunity to reduce the burden of COVID-19. Bariatric surgery, which is the most effective treatment in producing sustained, long-term weight loss, came to a standstill globally with the COVID-19 pandemic. Hence, there is a lot of interest in restarting bariatric surgery safely. The two opposing views we highlight might only add to the confusion in the field. A wider consensus is needed to ensure this life-saving treatment is delivered to patients in a timely manner. We declare no competing interests. Bariatric and metabolic surgery during and after the COVID-19 pandemic: DSS recommendations for management of surgical candidates and postoperative patients and prioritisation of access to surgeryThe coronavirus disease 2019 pandemic is wreaking havoc on society, especially health-care systems, including disrupting bariatric and metabolic surgery. The current limitations on accessibility to non-urgent care undermine postoperative monitoring of patients who have undergone such operations. Furthermore, like most elective surgery, new bariatric and metabolic procedures are being postponed worldwide during the pandemic. When the outbreak abates, a backlog of people seeking these operations will exist. Full-Text PDF Bariatric and metabolic surgery during and after the COVID-19 pandemicIn The Lancet Diabetes & Endocrinology, Francesco Rubino and colleagues discussed the prioritisation of bariatric and metabolic surgery during and after the COVID-19 pandemic.1 We congratulate the authors for bringing up this important discussion, since difficulties around future care of obesity and type 2 diabetes might be a major problem within this context.We would like to point out, however, our disagreement with the algorithm for prioritisation for bariatric and metabolic surgery in patients with type 2 diabetes. Full-Text PDF Bariatric and metabolic surgery during and after the COVID-19 pandemicThe COVID-19 pandemic has caused serious disruptions to the health-care system and has revealed substantial racial, ethnic, socioeconomic, and other health-care disparities. The role of obesity has also been highlighted, as obesity severity appears to be related to higher rates of hospitalisation and poorer clinical outcomes of COVID-19.1 Obesity treatment has been hugely affected by the pandemic, leaving millions of children, adolescents, and adults at high risk for worsening comorbidities, with less access to treatment and increased risk for poor outcomes from COVID-19. Full-Text PDF Bariatric and metabolic surgery during and after the COVID-19 pandemic – Authors' replyWe sincerely appreciate the comments by Bruno Halpern and Marcio Mancini about our Personal View on bariatric and metabolic surgery during and after the COVID-19 pandemic.1 We take this opportunity to clarify the objectives of the Diabetes Surgery Summit (DSS) recommendations regarding the prioritisation of patients who are already candidates for bariatric or metabolic surgery. The authors assert that individuals with diabetes and established cardiovascular disease should be treated with SGLT2 inhibitors or glucagon-like peptide-1 receptor agonists instead of bariatric or metabolic surgery, because the former have been shown in randomised controlled trials to reduce cardiovascular disease, whereas there is less evidence for that with bariatric and metabolic surgery in this population. Full-Text PDF