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Surgery for Obesity and Related Diseases - (2021) 1–2 Editorial comment When to perform bariatric surgery after COVID-19 infection In the current letter [1], the authors reported 2 cases of pa- the relation with our previous manuscript is extremely tients with previous COVID-19 infection scheduled for bar- limited. iatric surgery, as a reply to our initial manuscript [2]. They should be commended for inciting bariatric professionals to Marius Nedelcu, M.D. progress in order to better address the history of COVID and ELSAN future bariatric surgery, but their letter is lacking important Clinique Bouchard information about these 2 cases, especially regarding their Marseille, France clinical status and preoperative pulmonary functional tests. ELSAN The attitude against this COVID-19 pandemic was distinc- Clinique Saint Michel tive among different countries at different periods for the Toulon, France last 15 months. However, a patient with bilateral pneumonia Ludovic Marx, M.D. who requires oxygen therapy and azithromycin per os but ELSAN not hospitalization should alert us during bariatric preoper- ative work-up. The authors’ letter suggest that this was a Clinique Orangerie Strasbourg, France benign evolution (with no need of hospitalization) of the COVID -19 infection, which is highly debatable in a case Rami Edward Lutfi, M.D. with azithromycin and oxygen therapy. Chicago Institute of Advanced Surgery Our main criticism of the Vitiello et al. letter [1] is related University of Illinois to a presumed recommendation of our manuscript supports a Chicago, Illinois 4-week interval between the infection and bariatric surgery. Ramon Vilallonga, M.D., Ph.D. Vitiello et al. have misunderstood our conclusion and completely neglect our use of the term “minor.” Our manu- ELSAN Clinique Saint Michel script [2] reported 35 patients who underwent different pro- Toulon, France cedures of bariatric surgery after previous COVID-19 Universitat Autonoma de Barcelona infection. We remind the authors that the mean interval Barcelona, Spain time from COVID infection to the bariatric surgery in our Endocrine, Metabolic and Bariatric Unit, General Surgery manuscript was of 11.3 weeks (3–34 wk) and not 4 weeks. Department The purpose of our current letter is to explain better the in- Hospital Vall d’Hebron terval between COVID-19 infection and bariatric surgery. The management should be different for completely asymp- Barcelona, Spain tomatic cases and the 2 cases reported in your letter that Victor Diaconu, M.D., Ph.D. could not be considered minor cases (azithromycin and ox- Provita Clinic ygen therapy). For such cases, equally in our practice, bar- Bucharest, Romania iatric surgery would be performed after a longer period Shadi Aboudi, M.D. and further investigations (e.g., CT scan or pulmonary func- Chicago Institute of Advanced Surgery tional tests) which should be considered mandatory. It is University of Illinois legitimate for any bariatric team to propose these new tools which should also be evaluated in larger prospective clinical Chicago, Illinois trials. Artur Cirera de Tudela, M.D. Moreover, the current letter does not report any bariatric Universitat Autonoma de Barcelona surgery with outcome analysis. Did the authors operate on Barcelona, Spain these 2 patients? After which interval, and what are the Endocrine, Metabolic and Bariatric Unit, General Surgery recorded outcomes? We considered that this type of infor- Department mation was essential for the initial letter. The authors are Hospital Vall d’Hebron to be commended for reporting these 2 clinical cases, but Barcelona, Spain 2 Marius Nedelcu et al. / Surgery for Obesity and Related Diseases - (2021) 1–2 Jose Vicente Ferrer, M.D., Ph.D. Sergio Carandina, M.D., Ph.D. Hospital San Rafael ELSAN Clinica Obesitas Clinique Saint Michel Madrid, Spain Toulon, France Department of Digestive and Bariatric Surgery Jose Ramirez, M.D., Ph.D. Clinica Madonna della Salute Hospitales San Roque Maspalomas Porto Viro, Italy Canary Islands, Spain Patrick Noel, M.D. Received 28 June 2021 ELSAN Accepted 1 July 2021 Clinique Bouchard Marseille, France References Emirates Specialty Hospital Dubai, United Arab Emirates [1] Vitiello A, Berardi G, Velotti N, Bardi U, Musella M. Comment on: bariat- ric surgery in patients with previous COVID-19 infection. Surg Obes Relat Anamaria Nedelcu, M.D. Dis. Epub 2021 Jun 12. https://doi.org/10.1016/j.soard.2021.05.033. ELSAN [2] Nedelcu M, Marx L, Lutfi RE, et al. Bariatric surgery in patients with previous COVID-19 infection. Surg Obes Relat Dis 2021;17(7):1244–8. Clinique Saint Michel Toulon, France https://doi.org/10.1016/j.soard.2021.07.001