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How should we plan bariatric surgery (Gastric Sleeve, or Gastric Bypass) in the context of the unprecedented pandemic caused by the novel coronavirus?  

What advice do we have for our patients?

Believe me, we’ve been thinking and talking a LOT about this over the past couple of weeks.  The situation is so dynamic that it’s been impossible to lay out a plan that will last for a week or sometimes even for a day.  Fortunately, we have a clear guiding principle to help us navigate the rapidly changing terrain: WE ARE COMMITTED TO DOING WHAT IS BEST FOR OUR PATIENTS, OUR TEAMS, AND FOR SOCIETY.  

Given the apparent potential for the novel coronavirus to infect so many, so quickly, and to possibly overwhelm our healthcare system, the obvious plan at this moment is for us to stop, hunker down, and watch to see what is really happening.  We are stopping almost all surgery, for now, to reduce social/medical exposure for our patients and our team, and to avoid consuming any resources that might be needed to treat those who are ill with COVID-19. My impression is that we’ll need to stay on hold until the curve tracking new COVID-19 cases starts to flatten out; that’s when we should be able to see where we all stand in terms of risk and in terms of the burden on the healthcare system.

We are confident that a time will come again when bariatric surgery is a good idea.  In fact, bariatric surgery will likely turn out to be a protective intervention in case this novel coronavirus becomes a persisting/recurring problem.  The available data indicate that patients who become very ill with the novel coronavirus suffer from respiratory failure, and that patients with high blood pressure and diabetes are at higher risk of death or other health consequences.  As of March 23, I’m not aware of any data that indicates a higher risk for COVID-19 in those who suffer from the Obesity Disease but it seems very reasonable to hope that bariatric surgery could substantially reduce risk through improved respiratory status, remission of diabetes and remission of high blood pressure.  

In the world of COVID-19, many people ask about bariatric surgery and immune function.  It’s probably true that surgical stress reduces immune function for around 2 weeks, but after surgical recovery, we can look forward to substantial immune benefits.  Without surgery, the Obesity Disease causes the body’s immune/inflammatory system to be up-regulated, over-active, and off-target.  In other words, people with the Obesity Disease have some degree of immune deficiency because the Obesity Disease itself disrupts and distorts normal immune function.  As a patient’s weight and hormone balance improve following bariatric surgery, we see them recover to normal immune function.

Here at the end of March 2020, we can’t tell when it will be appropriate to resume bariatric surgery.  We are going to track developments week-by-week and day-by-day. But we can be sure that the right time will come, a time that’s right not only for our patients but also for society as a whole.  When the right time comes, we’ll be taking our patients to facilities that are focused on elective surgery, meaning that those facilities handle patients who are healthy other than their need for surgery.  We will assiduously track the local details of COVID-19, and will not expose our patients to any situation where the disease is known to be active.  

When we accomplish Sleeves and Gastric Bypasses once again, we are confident that we’ll be helping our patients and their loved ones against this new threat just as we have long battled diabetes, sleep apnea, and the rest.

John Pilcher

for Sage Bariatric Institute