Previous COVID-19 Infection Undergoing Bariatric Surgery

The study, “Lingering SARS-CoV-2 in Gastric and Gallbladder Tissues of Patients with Previous COVID-19 Infection Undergoing Bariatric Surgery,” investigated the presence of SARS-CoV-2 nucleocapsid in gastric and gallbladder tissues from patients who had recovered from COVID-19.

Here’s a detailed summary:

Background and Purpose: This study aimed to detect lingering SARS-CoV-2 nucleocapsids in the gastric and gallbladder tissues of patients who had previously contracted COVID-19 but tested negative before undergoing bariatric surgery. This was significant because lingering SARS-CoV-2 in gut tissue could be a source of infection during surgery​​.

Study Design: Conducted between November 2021 and May 2022 at Madina Women’s Hospital in Alexandria, Egypt, this prospective study involved patients who had recovered from COVID-19 and showed gastrointestinal symptoms. These patients underwent laparoscopic sleeve gastrectomy (LSG) procedures, and their tissues were analyzed for the presence of SARS-CoV-2 nucleocapsid proteins​​.

Participants: The study included 80 patients who had a history of COVID-19 with gastrointestinal symptoms and negative PCR test results at the time of their surgery​​.

Methodology: Gastric and gallbladder specimens were collected, fixed in formalin, and processed into paraffin blocks. These samples were then stained using immunohistochemistry with monoclonal antibodies against the SARS-CoV-2 nucleocapsid protein. Serological anti-spike IgG responses were also measured​​.

Findings: Positive cytoplasmic staining for the SARS-CoV-2 nucleocapsid protein was observed in 32.5% of gastric specimens and 100% of cholecystectomy specimens. Most patients in the study were female, with an average BMI of 44.2 kg/m2. The group with positive tissue staining was significantly younger than the group with negative staining. A strong positive serological anti-spike IgG response was observed in 99% of the patients​​.

Symptoms and Vaccination: All patients had experienced one or more gastrointestinal symptoms during their COVID-19 infection. Approximately 58.75% were fully vaccinated, and 32.5% were not vaccinated​​.

Implications and Conclusions: The study’s results are crucial in understanding the behavior and impact of SARS-CoV-2 on healthcare practices. It highlights the possibility of virus particles persisting in the body long after recovery from COVID-19, which may be linked to long COVID syndrome or late postoperative complications. Importantly, the study suggests that handling stomach specimens from patients during surgery should be done with increased care, considering that a third of patients might have lingering virus particles. However, undergoing LSG did not seem to increase perioperative morbidity​​.

Limitations and Future Research: The study did not assess the infectivity of the viral particles found in tissues, and the possibility of reinfection at the time of surgery could not be ruled out. Future research should include a larger sample size to obtain more reliable answers and consider the potential for bias and confounding factors​​.

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