Lingering SARS-CoV-2 in Gastric and Gallbladder Tissues of Patients with Previous COVID-19 Infection Undergoing Bariatric Surgery.

BACKGROUND: Lingering severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) in gut tissue might be a source of infection during bariatric surgery. This study aimed to confirm the presence of SARS-CoV-2 nucleocapsid in gastric and gallbladder tissues removed during bariatric surgery in individuals previously infected with coronavirus disease 2019 (COVID-19) who had negative polymerase chain reaction results prior to the surgery. METHODS: Gastric and gallbladder specimens from 80 patients who underwent bariatric surgery between November 2021 and May 2022 and had a history of COVID-19 infection with gastrointestinal symptoms were examined for the presence of lingering SARS-CoV-2 nucleocapsid proteins using immunohistochemistry. RESULTS: Gastric specimens from 26 (32.5%) patients and 4 (100%) cholecystectomy specimens showed positive cytoplasmic staining for the anti-SARS-CoV-2 nucleocapsid protein in surface mucosal epithelial cells. The mean age was 37.8 ± 10.3 years. The average body mass index was 44.2 ± 7.0 kg/m2; most of the patients were females (71.3%). The positive staining group was significantly younger than the negative staining group (p = 0.007). The full-dose vaccination rate was 58.8%, with a median of 91 days after the last vaccine dose. A positive serological anti-spike IgG response was observed in 99% of the patients. The median time between initial COVID-19 infection and surgery was 274 and 380 days in the positive and negative staining groups, respectively (p = 0.371). CONCLUSION: Gastric and gallbladder tissues can retain SARS-CoV-2 particles for a long time after COVID-19 infection, handling stomach specimens from patients during an operation must be done with care, as we usually do, but now with the knowledge that in 1/3 of patients they can be present. Performing LSG on post-COVID patients did not seem to increase perioperative morbidity.

Impact of bariatric surgery on the effectiveness of serological response after COVID-19 vaccination.

PURPOSE: The primary objective of the current study is to determine whether bariatric surgery reversed the negative impact of obesity on the serological response after the COVID-19 vaccination. This objective is achieved in two steps: (a) quantifying the negative impact of obesity on the serological response after COVID-19 vaccination if it is present, and (b) testing whether bariatric surgery reversed this impact. The secondary objective was to monitor the occurrence of adverse events. METHODS: This is a prospective cohort study between May 2021 and August 2021 on the strength of serological response after COVID-19 vaccination. Patients were classified into three groups. Group A (controls with normal or overweight), Group B (bariatric patients pre-operative), and Group C (bariatric patients post-operative). Quantitative antibodies against SARS­CoV­2 RBD with a strong neutralizing capacity were quantified from sera after at least 2 weeks post-vaccination. RESULTS: Of the 276 participants, Group A had n = 73, Group B had n = 126, and Group C had n = 77 patients. Overall, a strongly positive vaccine serological response was observed among 86% in group A, 63% in Group B, and 88% in Group C. Group C showed 5.33 times [95% CI 2.15 to 13.18] higher immune response than group B. Mild to moderate adverse events occurred in 30.1% [95% CI 24.7 to 35.9] of the study samples. Adverse events with the whole virus, mRNA, and vector vaccines occurred in 25%, 28%, and 37%, respectively. CONCLUSION: Vaccinating and bariatric surgery are safe and effective treatments in the serological response in patients who suffer from obesity.

Incidence and presentation of COVID-19 in the vaccinated and unvaccinated patients undergoing bariatric surgery

Background This study aimed to describe the incidence and clinical presentation of fully vaccinated and unvaccinated patients who tested positive for COVID-19 in the first year after Madina Women’s Hospital in Alexandria, Egypt, resumed bariatric surgery procedures. (The clinic was closed between March 2020 and reopened in mid-October 2020) Methods This prospective cohort study was conducted between November 2020 till the end of December 2021. We identified patients undergoing bariatric surgery infected with COVID-19 with and without vaccination. COVID-19 severity was assessed based on the Egypt Ministry of Health guidelines. Some patients were isolated at home, whereas others were hospitalised. Results During the one year after the restart of bariatric surgery procedures, 606 patients underwent bariatric procedures (n = 280 fully vaccinated, n = 320 unvaccinated). During follow-up, that period, the incidence of COVID-19 in the vaccinated group was 1.07% (n = 3) versus 14.1% (n = 46) in the unvaccinated group. Three patients had mild symptoms in the vaccinated group, and no hospital admission was necessary. In the unvaccinated group, 27 patients (60%) were classified as mild, eight (17.8%) as moderate, eight (17.8%) as moderate with risk, and two (4.4%) as severe;the mortality rate was 0%. Of these, 16 (88.9%) were hospitalised, of which six (33.3%) were admitted to the intensive care unit in the moderate to severe groups. Conclusion Patients with obesity are at increased risk for COVID-19 infection and adverse consequences. Our findings showed a higher incidence of COVID-19 among those unvaccinated versus vaccinated. Therefore, at least during times and locations of a COVID-19 pandemic, vaccinations may be beneficial for patients against COVID-19 prior to bariatric surgery.