ABCD Arq Bras Cir Dig

2025;38:e1878 Original Article

https://doi.org/10.1590/0102-6720202500009e1878

AIMPACT
QUEDAOF DATHE COVID-PORTAL
PRESSÃO APÓS DESVASCULARIZAÇÃO
19 QUARANTINE ON THE MENTAL AND
EMOTIONAL HEALTHE OF
ESOFAGOGÁSTRICA POST-BARIATRIC
ESPLENECTOMIA SURGERY A
INFLUENCIA WOMEN:
VARIAÇÃO
A QUALITATIVE STUDY
DO CALIBRE DAS VARIZES E AS TAXAS DE RESSANGRAMENTO NA
ESQUISTOSSOMOSE NO SEGUIMENTO
IMPACTO DA QUARENTENA DA COVID-19 NA SAÚDE MENTALEM LONGODEPRAZO?
E EMOCIONAL MULHERES PÓS-CIRURGIA
BARIÁTRICA: UM ESTUDO QUALITATIVE
Does the drop in portal pressure after esophagogastric devascularization and splenectomy
Alisson Padilha de LIMA1,2 , Isabela Gouveia MARQUES2,3 , Karla Fabiana GOESSLER2,3 , Roberto DE CLEVA4 ,
variation of variceal calibers and the rebleeding rates in schistosomiasis in late follow-up?
Marco Aurélio SANTO4 , Hamilton ROSCHEL2,3 , Bruno GUALANO2,3 , Fabiana Braga BENATTI3,5

Walter de Biase SILVA-NETO1 , Claudemiro QUIRESE1 , Eduardo Guimarães Horneaux de MOURA2 ,

Fabricio Ferreira COELHO3 , Paulo HERMAN3
ABSTRACT – BACKGROUND: The coronavirus disease 2019 (COVID-19) greatly impacted patients
undergoing bariatric surgery due to prolonged quarantine and lockdown measures. AIMS: The aim
RESUMO - Racional: O tratamento de escolha para pacientes com hipertensão portal
of this study was to qualitatively investigate the impact of the COVID-19 quarantine and lockdown
esquistossomótica
measures on the mental com and sangramento de varizes
emotional health é a desconexão
of post-bariatric ázigo-portal
surgery women. METHODS:maisA
esplenectomia
qualitative study(DAPE) associada
was carried à terapia
out, with endoscópica.
individual Porém, estudos
interviews conducted mostram
via video aumento
calls using a video-
do calibre das varizes
communication serviceem alguns
(Google pacientes
Meet ®
durante o guide
). The moderator seguimento
inquiredem longo
about prazo.
three Objetivo:
pre-established
topics based on the literature:
Avaliar o impacto da DAPE e tratamentomental and endoscópico
emotional health, social relationship,
pós-operatório and the use of
no comportamento
health technology. RESULTS: A total of 12 women participated in this study, with an average age
das varizes esofágicas e recidiva hemorrágica, de pacientes esquistossomóticos. Métodos:
of 43±9.83 years, a body mass of 82.33±13.83 kg, a height of 1.62±0.06 m, a body mass index of
Foram estudados
26.32±2.97 36 pacientes
kg/m2, and com
post-surgery timeseguimento superior
of 12.83±4.37 months.a cinco anos, distribuídos
The interviews em
had an average
dois grupos:
duration queda damin.
of 50.71±7.26 pressão portal suggested
Our results abaixo de a30% e acima
negative de 30%
impact of thecomparados com o
COVID-19 pandemic
calibre das varizes
on aspects esofágicas
of mental no pós-operatório
and emotional health, such asprecoce e tardio
increased anxiety,além do índice
depressive de recidiva
symptoms, fear,
stress, and anguish,
hemorrágica. which were somehow diminished in patients who were closer to family members.
Resultados Figure 3. Mental and emotional health words cloud.
Bariatric surgery was mentioned as a positive aspect by the patients for coping with clinical risk
esofágicas que, durante o seguimento aumentaram de calibre e foram controladas com
conditions. CONCLUSIONS: The study showed a negative impact of the COVID-19 pandemic on
aspects of mental and emotional health mostly due to lockdown measures, which led to social Evolução do calibre das varizes no período pré e pós-
Central Message
oisolation
comportamento do calibre
and an increased das
burden varizes
with no pós-operatório
household chores. precoce nem tardio nem os operatório precoce e tardio
índices deBariatric
HEADINGS: recidiva hemorrágica.
Surgery. COVID-19.Conclusão
Mental Health. Women’s Health. Although social distancing measures were
effective in preventing COVID-19 infection,
mobility restrictions, lack of social interaction, and
operatórios precoces ou tardios. A comparação entre a queda de pressão do portal e as Mensagem central
limitation of daily activities impacted individuals’
Amental
desconexão ázigo-portal
health, generating e esplenectomia
frustration, feelings of
RESUMO – RACIONAL:
DESCRITORES: A doença
Esquistossomose mansoni.Coronavírus
Hipertensão2019 (COVID-19)
portal. impactou
Cirurgia. Pressão fortemente
na veia osesofágicas
porta. Varizes pacientes apresenta
insecurity, importante
confusion, impacto
emotionalnaisolation,
diminuição
and
submetidos à cirurgia bariátrica devido às medidas prolongadas de quarentena e bloqueio.
e gástricas. stigma. Indeed,
precoce several
do calibre dasquantitative studies have
varizes esofágicas na
OBJETIVOS: Este estudo teve como objetivo investigar qualitativamente o impacto das medidas demonstrated various
esquistossomose; psychological
entretanto, parece symptoms
que a
de quarentena e bloqueio da COVID-19 na saúde mental e emocional de mulheres pós-cirurgia arising from
associação comthe COVID-19
a terapia quarantine,
endoscópica é asuch as
maior
bariátrica. MÉTODOS: Foi realizado um estudo qualitativo, com entrevistas individuais realizadas emotional pelo
imbalance,
responsável controledepression, stress, lack of
da recidiva hemorrágica.
por meio de chamada de vídeo, utilizando um serviço de vídeo comunicação (Google Meet®). mood, irritability, insomnia, post-traumatic stress
ABSTRACT
Um guia -moderador
Background:com The treatment
perguntas sobreof choice
três temasfor patients with com
pré-estabelecidos schistosomiasis with
base na literatura symptoms, anger, and emotional exhaustion in
previous episode
foi realizado: saúdeof varices
mental eis emocional;
bleeding esophagogastric devascularization
relacionamento social; and splenectomy
e uso de tecnologia em saúde. working conditions. These effects have been
(EGDS) in association
RESULTADOS: with postoperative
Participaram deste estudo 12 endoscopic
mulheres, comtherapy.
idadeHowever,
média destudies
43±9,83have
anos,shown
massa Perspectiva
particularly detrimental to people with obesity,
corporalrecurrence
varices de 82,33±13,83 quilogramas,
especially altura de 1,62±0,06
after long-term follow-up.metros,
Aim: índice de massa
To assess corporalon
the impact de withestudo
reportsavaliou
of increased anxiety and depression
Este o impacto tardio no índice
26,32±2,97
behavior ofkg/m
2
e tempo
esophageal pós-operatório
varices de 12,83±4,37
and bleeding recurrence meses.
afterAspost-operative
entrevistas tiveram duração
endoscopic dueressangramento
to social isolation
de de measures.
pacientes submetidos ao
média de 50,71±7,26 minutos. Nossos resultados sugeriram um impacto negativo da pandemia
treatment
de COVID-19 of patients
em aspectossubmitted
da saúde to mental
EGDS. eMethods:
emocional, Thirty-six patientsdasubmitted
como aumento ansiedade,tosintomas
EGDS tratamento cirúrgico e endoscópico. A queda na
depressivos, medo, estresse e angústia, que foram de alguma forma diminuídos em pacientes mais
portal
próximospressure drop, more
de familiares. or lessbariátrica
A cirurgia than 30%, foiand compared
citada como aspectowith the behavior
positivo pelosofpacientes
esophageal
para Perspectives
variação do calibre das varizes quando comparado
o enfrentamento
varices and the ratedasofcondições
bleeding clínicas de risco.
recurrence. CONCLUSÕES: O estudo mostrou um impacto
Results oThe
seu diâmetro no pré ae pós-operatório
study showed negative impactprecoce e
of the
negativo da pandemia de COVID-19 em aspectos da saúde mental e emocional, principalmente tardio.
COVID-19A comparação
pandemicentre on aaspects
queda de
of pressão
mental
late post-operative varices caliber when compared the pre-operative data was observed portal e as taxas de ressangramento, também
devido a medidas de confinamento que levaram ao isolamento social e a um aumento da carga de and emotional health mostly due to lockdown
despite an increase
tarefas domésticas. in diameter during follow-up that was controlled by endoscopic therapy. measures, which led to social isolation and an
Conclusion Cirurgia Bariátrica. COVID-19. Saúde Mental. Saúde da Mulher.
DESCRITORES: evidenciar se apenas
increased burden with ahousehold
terapia endoscópica, ou
chores. However,
variceal calibers when comparing pre-operative and early or late post-operative diameters. bariatric surgery
operações was mentioned
menos complexas poderãoascontrolar
a positive
o
The comparison between the portal pressure drop and the rebleeding rates was also not aspect of coping
sangramento with clinical risk conditions.
das varizes.
Additionally, for some patients, the quarantine did
provide the opportunity to spend more time with
HEADINGS: Schistosomiasis mansoni. Portal hypertension. Surgery. Portal pressure. children, spouses, and other family members.
Esophageal and gastric varices.

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From 1Faculdade IELUSC, School of Physical Education – Joinville (SC), Brazil; 2Universidade de São Paulo, Faculdade de Medicina, Hospital das Clínicas, Center
of Lifestyle Medicine; Laboratory of Assessment and Conditioningwww.instagram.com/abcdrevista
www.facebook.com/abcdrevista in Rheumatology – São Paulo (SP), Brazil;www.twitter.com/abcdrevista
3
Universidade de São Paulo, Faculdade de Medicina,
Escola de Educação Física e Desporto, Applied Physiology and Nutrition Research Group – São Paulo (SP), Brazil; 4Universidade de São Paulo, Faculdade de
Medicina, Department of Gastroenterology – São Paulo (SP), Brazil; Universidade Estadual de Campinas, Faculdade de Ciências Aplicadas – Limeira (SP), Brazil.
5

Trabalho realizado no 1Serviço de Cirurgia Geral e Aparelho Digestivo, Departamento de Clínica Cirúrgica, Faculdade de Medicina, Universidade Federal de Goiás, Goiânia, GO,
How 2to
Brasil; cite this
Serviço article: LimaHospital
de Endoscopia, AP, Marques IG, Goessler
das Clínicas KF, de Cleva
e Departamento R, Santo MA, Roschel
de Gastroenterologia, H, etdeal.Medicina,
Faculdade Impact of the covid-19
Universidade de quarantine on Paulo,
São Paulo, São the mental and3Serviço
SP, Brasil; emotional
de
health do
Cirurgia of post-bariatric
Fígado, Hospitalsurgery women:
das Clínicas a qualitativede
e Departamento study. ABCD Arq Bras
Gastroenterologia, Cir Dig. de
Faculdade 2025;38e1878. https://doi.org/10.1590/0102-6720202500009e1878.
Medicina, Universidade de São Paulo, São Paulo, SP, Brasil

Como citar esse artigo: de Biase Silva-Neto WB, Quirese C, De Moura EGH, Coelho FF, Herman P. A queda da pressão portal após desvascularização esofagogástrica e esplenectomia
Correspondence: Financial source: Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES (88887.473556/2020-00; CAPES
Fabiana Braga Benatti. Finance Code #001), and Fundação de Amparo à Pesquisa do Estado de São Paulo – FAPESP (Grants #2016/10993-5;
/10.1590/0102-672020210001e1581
E-mail: [email protected] #2019/17912-9). Fundação de Apoio ao Ensino, Pesquisa e extensão – Universidade Estadual de Campinas (FAEPEX; # 2176/23).
Alisson Padilha de Lima. Conflict of interests: None
Correspondência:
Email: [email protected] Received: 03/21/2024
Walter De Biase da Silva Neto
Accepted: 10/15/2024
E-mail: [email protected]; Recebido para publicação: 17/09/2020
Editorial Support: National Council for Scientific
[email protected] andpublicação:
Aceito para Technological Development (CNPq).
14/12/2020

ABCD Arq Bras Cir Dig 2021;34(2):e1581 1/4

1/9
ORIGINAL ARTICLE

INTRODUCTION this study aimed to qualitatively investigate the impact of the

B
COVID-19 quarantine and lockdown measures on the mental
ariatric surgery is the cornerstone treatment for and emotional health of post-bariatric surgery women.
severe obesity12, with a high success rate of long-
term weight loss and substantial improvements
in metabolic health8,32,35. However, adequate post-surgery
follow-up is crucial to help patients achieve the estimated METHODS
weight loss and improvements in comorbidities36, in addition
to preventing potential psychological disorders that may arise This study utilized the Consolidated Criteria for Reporting
following surgery13. Qualitative Research (COREQ)33. This study is part of a larger
The coronavirus disease 2019 (COVID-19) also had randomized clinical trial aimed at gathering knowledge about
profound impacts on patients undergoing bariatric surgery, the potential benefits of physical exercise in patients undergoing
particularly due to the limited access to health care in the face bariatric surgery (NCT02441361). Data reported herein were
of the prolonged quarantine and lockdown measures necessary collected during the pandemic, and patients digitally provided
to contain the virus spread. This has resulted in detrimental their informed consent.
effects on long-term postoperative health, such as deterioration
of long-term outcomes and lower weight losses36. Participants
Although social distancing measures were effective in The participants in this study were recruited from the
preventing COVID-19 infection, mobility restrictions, lack of Gastroenterology Department, Digestive Surgery Division of
social interaction, and limitation of daily activities impacted the Hospital de Clínicas. A convenience sample of women
individuals’ mental health, generating frustration, feelings who underwent bariatric surgery was selected. The inclusion
of insecurity, confusion, emotional isolation, and stigma6,20,28. criteria were female patients, aged 20–60 years, those who
Indeed, several quantitative studies have demonstrated various underwent bariatric surgery (Roux-en-Y gastric bypass and
psychological symptoms arising from quarantine8,30, such as sleeve gastrectomy) in the past 12 months, and those who
emotional imbalance16, depression10, stress14, lack of mood21, did not participate in any exercise training protocol during the
irritability21, insomnia21, post-traumatic stress symptoms21, period of quarantine of the COVID-19 pandemic lockdown in
anger23,29, and emotional exhaustion in working conditions24. São Paulo, from March 2020 to May 2020.
Likewise, qualitative studies have found other psychological We emphasize that the exclusion criterion adopted for
responses from the quarantine, such as confusion5,10, fear9,14, patients who participated in the physical exercise program was
anger10, pain9, numbness37, and anxiety-induced insomnia14. that these patients were part of the clinical trial and received
These effects have been particularly detrimental to people follow-up and intervention for 6 months, while patients in the
with obesity, with reports of increased anxiety and depression control group only had follow-up. Patients with a post-operative
due to social isolation measures22. In addition to the psychological period exceeding 12 months, internet access limitations, and
aspects that affect mental health during the quarantine and mental disorders that prevented the interview from being
that may persist thereafter, some specific stressors to this carried out were not eligible, as depicted in Figure 1.
population can include longer confinement, inadequate supplies,
difficulty in obtaining health care, and financial difficulties6. Research instruments
Moreover, women, who are more commonly responsible for A guiding script was used to conduct individual interviews
the bulk of domestic tasks3, may have been more impacted. for data collection. The interviews were conducted by male
Thus, it is possible that COVID-19 and lockdown measures postgraduate students and female postgraduate students, both
have highly impacted the mental health of women undergoing researchers, with previous experience in qualitative studies.
bariatric surgery. As they may face a heavier burden in dealing A video call was scheduled using a video-communication
with the pandemic, it becomes fundamental to identify, service (Google Meet®) on the participants’ preferred day and
understand, and advocate for their mental health since some time, with participants being at home. A pilot test was conducted
of the pandemic-associated negative impacts on well-being and before the beginning of the research with two patients, who did
overall health may carry over in the long run. In this context, not participate in the protocol, to adjust the instructions and

Women participating in thematic project: “Effects of a

physical exercise program on obese individuals
undergoing bariatric surgery” (n=30)

Excluded:
- Did not participate because they were engaged in an
exercise intervention program (n=15)

Eligible (n=15)

Declined:
- Time limitations (n=1)
- There was no good internet signal for the interviews
(n=2)

Interviewed (n=12)
Figure 1 - Flowchart of the recruitment process.

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 IMPACT OF THE COVID-19 QUARANTINE ON THE MENTAL AND EMOTIONAL HEALTH OF POST-BARIATRIC SURGERY WOMEN: A QUALITATIVE STUDY

questions of the study. The moderator guide inquired about In addition to the thematic analysis, we used word cloud
three pre-established topics based on the current literature: analysis to shed light on the themes most addressed by the
mental and emotional health, social relationship, and the use participants during the interviews. The figures were created
of health technology. using the Pro Word Cloud tool found in the office package
The “mental and emotional health” and “social relationship” Word 2016®.
topics were pre-established according to previously published
studies that demonstrated the impact of the COVID-19 Ethical aspects
pandemic on patients who had undergone bariatric surgery, This research involved human beings, and all procedures
and the consequent restricted access to health care (including carried out here respected the ethical principles described in
medical, nutritional, and psychological consultations) during the 1964 Declaration of Helsinki and its current amendments.
the quarantine period, which could be harmful to long-term The project was approved by the Ethics and Research Committee
postoperative health20,28,30,36. Due to its relevance during the of the University Hospital, School of Medicine, Universidade
pandemic, we added the topic “use of technology for health de São Paulo (number: 4.294.103). Informed consent was
care,” as it yielded online consultations with specialists and obtained digitally (via Google Forms®) from all participants
telemedicine strategies to reduce the negative effects of the included in the study.
pandemic on health15,22,36.
In addition to the pre-established script as a guide, the
moderators used probing questions that inquired participants
about the impact COVID-19 had on their mental and emotional RESULTS
health, as summarized in Table 1.
A total of 12 women participated in this study, with an
Data analysis average age of 43±9.83 years, a body mass of 82.33±13.83 kg, a
The interviews were transcribed verbatim in Portuguese height of 1.62±0.06 m, a body mass index of 26.32±2.97 kg/m2,
and translated to English by bilingual and bicultural researchers. and surgery time of 12.83±4.37 months. Interviews averaged
Thematic analysis was conducted by following three steps 50.71±7.26 min of duration. Other characteristics of the sample
according to previous literature34. are shown in Table 2.
1. Pre-analysis: Organization of the material in order to After thematic analysis of the content of the participants’
prepare it for the identification of the central idea. Pre- speech, the results were organized into topics and subtopics,
analysis was configured as the data organization phase as depicted in Figure 2.
itself, characterized as a moment of researcher’s intuition,
aimed to operationalize and systematize the initial ideas Early effects of the pandemic on mental health
of data collection, culminating in an analysis plan. The pre-
analysis phase consisted of three missions: the choice of Anxiety
documents to be analyzed; the formulation of hypotheses Anxiety was one of the main aspects that influenced
and objectives; and the construction of indicators that the mental health of bariatric patients. Notably, patients who
will support the final interpretation. These aspects of the were able to stay with their families had more control over
first phase of analysis are interconnected but may not their symptoms.
follow a chronological order34.
2. Exploration of the material: In-depth study of the data, There was no tranquility at all; in the beginning of
aiming to identify the nuclei of meaning. After the pre- the pandemic, I felt more anxious and worried; I feel
analysis phase and its different stages were satisfactorily calmer now but there is no such thing as “tranquility”
completed, the material exploration phase was constituted [...] (BAR 1)
as the systematic application of the decisions made, I even had to take some medication to decrease my
configuring itself in coding, decomposition, or enumeration anxiety [...] (BAR 6)
operation, related to previously formulated rules34. I felt no impact because my family stayed together; I did
3. Treatment of the obtained data and interpretation: not have any anxiety; after I had surgery, I felt calm, even
Regrouping of the data with the similarity of their meanings during lockdown [...] (BAR 10)
and the discussion in light of the constructed framework34. I had a lot of anxiety and lost a lot of weight, but it got
For coding and content analysis, the software NVivo® better when later I was able to be closer to my family
version 11 was used. [...] (BAR 3)

Table 1 - Interview guide

Demographic and clinical characteristics
1. Age, body mass, height, body mass index, race, level of education, occupation, marital status, residence, surgery time, and type of
bariatric surgery
Mental and emotional health
2. - Positive probes: Tranquility, pleasure to stay at home, leisure time
- Negative probes: Stress, anxiety, depression, anguish, fear, insecurity
Social relationship
3. - Positive probes: More time with family, time to talk with people who are far away
- Negative probes: Family friction, arguments, division of domestic tasks, social distancing
Use of health technology
- Positive probes: Ease of access to the team of health professionals, freedom of choice of location and time for physical training,
greater independence to become physically active and maintain regular training, feeling pleasure (motivation) with the training, feel-
4.
ing able to take care of your health
- Negative probes: Lack of financial resources to access the Internet, difficulty handling mobile devices, difficulty understanding what
needs to be done, fear of causing injury
Source: The authors.

ABCD Arq Bras Cir Dig 2025;38:e1878 3/9

ORIGINAL ARTICLE

Table 2 - Characteristics of the sample

Participants Race Marital status Level of education Employment status Household members Type of surgery
BAR 1 Black Single High school Self-employed OFMs RYGB
BAR 2 Brown Married High school Homemaker Husband/sons RYGB
BAR 3 Brown Single High school Self-employed OFMs RYGB
BAR 4 White Married High school Employed Husband/sons RYGB
BAR 5 White Married High school Employed Husband/sons RYGB
BAR 6 White Married Higher education Employed Husband/sons RYGB
BAR 7 Brown Married Higher education Employed Husband/sons SG
BAR 8 Black Single Higher education Employed OFMs RYGB
BAR 9 Brown Widow High school Employed OFMs RYGB
BAR 10 White Married Higher education Employed Husband/sons SG
BAR 11 White Married High school Employed Husband/sons RYGB
BAR 12 Brown Single Higher education Self-employed OFMs RYGB
OFMs: Other family members; RYGB: Roux-en-Y gastric bypass; SG: Sleeve gastrectomy.

Early effects of the pandemic on mental health

Changes in lifestyle Influence of bariatric surgery Anxiety Depressive symptoms Fear and anguish Stress

Adapting lifestyle behaviors and social relationships in quarantine

Social distancing Family life during quarantine Housework during the pandemic Family leisure activities

Innovative solutions for health through technology in the pandemic

The importance of Technology and Technology as a tool to Technology and home-based Technology and the
technology and sedentary lifestyle become physically active exercises fight against obesity

Figure 2 - Flowchart resulting from the thematic analysis.

Depressive symptoms My biggest fear was contaminating my daughter. But I

Depressive symptoms were present in some bariatric was also afraid for myself because they said that my
patients, due to some factors such as staying at home for long immunity would be lower because I had the surgery. [...]
periods and deprivation of contact with people, especially I felt very insecure, and the anguish of being away from
family members and friends. the family, not being able to travel, not being able to go
out, and not being able to do anything generated more
There were moments when I got depressed, felt sad, anguish. (BAR 3)
wanting to cry for no specific reason [...] (BAR 1) You normally feel a lot of anguish after bariatric surgery
[...] because I stay at home a lot, I feel depressed [...] (BAR 4) and, when this virus came up, this feeling increased
I had depressive symptoms and was distressed because [...] (BAR 6)
some friends who worked at the bank were contaminated. At first, I was worried because my mother and father are
I was sad [...] (BAR 11) elderly and I was afraid of contaminating them. But after
I felt very impacted emotionally because we could not see a few days, I calmed down [...] (BAR 11)
our family members, so I got very depressed [...] (BAR 12)
For some patients, having chronic diseases before bariatric
Feelings of fear and anguish during the pandemic surgery made them consider themselves at risk during this
Fear and anguish were emotions reported by all patients, pandemic period.
mainly due to the negative consequences that COVID-19 could
cause before and after the surgery, the fear of contaminating The fear and anguish were very high, especially when
family members, in addition to the isolation from friends and my brother-in-law got COVID-19. I am in the risk group
family members. for having high blood pressure, diabetes, and asthma.
Furthermore, my whole family is also in the risk group
[...] We did not have peace of mind because we felt [...] (BAR 6)
that despair from the grocery shopping that we had
to wash and sanitize. We had to be very cautious when Quarantine stress
we got home because my mother is elderly, so we were Spending more time at home was one of the biggest
traumatized and afraid of contaminating ourselves and challenges for bariatric patients. In addition, external factors
transmitting it to others. (BAR 2) such as the interrupted work routine for some patients and

4/9 ABCD Arq Bras Cir Dig 2025;38:e1878

 IMPACT OF THE COVID-19 QUARANTINE ON THE MENTAL AND EMOTIONAL HEALTH OF POST-BARIATRIC SURGERY WOMEN: A QUALITATIVE STUDY

the intensified work routine for others, as well as the increased

time spent with family, favored the increase in stress during this
period, as well as an increased time spent with family favored
the increase in stress during this period.

[...] We spent more time at home, and with the new family
routine, stress levels increased. Men are more stressed
indoors, so my husband stayed a little longer, which made
me nervous too. (BAR 5)
In the first few months, there was more stress. As we
stayed together at home, there was family stress [...]
(BAR 10)
I am a health professional; at first, I spent practically the
Figure 3 - Mental and emotional health word cloud.
entire shift inside the operating room, and with that rush,
we were very stressed. (BAR 12)

Influence of bariatric surgery in coping with the pandemic Adapting lifestyle behaviors and social relationships
Many patients reported the importance of bariatric in quarantine
surgery as a treatment modality and preventive measure of
health problems, as it favors weight loss and reduces the Social distancing
symptoms of chronic diseases. Moreover, other precautions, Social distancing was one of the main challenges facing
such as the intake of vitamins associated with surgery, were the pandemic, and bariatric patients did it very carefully.
also considered as a preventive factor for coping with the Also, some preventive measures were mentioned during the
COVID-19 pandemic. quarantine period to minimize the risk of contamination, such
as hand sanitizing and the use of face masks.
If it was not for my bariatric surgery, I would not be here
doing this interview. Because my previous weight was We followed care and social distancing, used alcohol and
134 kilos and I had asthma, I would probably not resist masks, and washed our hands, that is what we were able
this virus. (BAR 2) to do at that moment. (BAR 6)
[...] After the bariatric surgery I was feeling stronger to We respect the social distance, do not receive anyone
face the pandemic [...] (BAR 9) at home, we are more isolated, and there was not even
[...] After the bariatric surgery I was calm, even in the a visit from family members. (BAR 9)
quarantine period [...] (BAR 10)
[...] Because of the vitamins we take after bariatric surgery, On the other hand, the restriction of family contact and
I feel I have a good immune system [...] (BAR 12) get-togethers was an impacting factor during the quarantine
period. This restriction was due to the advanced age of the
Impact of lockdown on lifestyle and mental health grandparents and to prevent the contamination of other family
Patients highlighted that the lack of physical activity and members (OFMs).
outdoor leisure activities and increased sedentary behavior
were factors that impacted mental health during quarantine We respect social isolation a lot, we stayed like this for
for bariatric patients. almost three months, only I would leave the house to buy
food and then come back because my grandmother is
It would be necessary to go to the gym, dance, and ninety years old and needed to be very careful. (BAR 10)
go out. These changes could improve my mental and We fully respect social distancing, leaving the house only
physical health, but now we must let go of that because to go to the market, and my father had this task. (BAR 11)
of the pandemic because I do not feel safe yet. (BAR 1)
[...] I became very sedentary because I couldn’t even Family life during quarantine
leave the house, and on my street, some people had To some patients, quarantine did provide rescue and
COVID [...] (BAR 4) the opportunity to spend more time with children, spouses,
and OFMs.
Patients also mentioned that the lack of psychological
follow-up, the possibility of getting vaccinated and, thus, returning It was great to spend more time with the family. I have
to their normal daily routine impacted their mental health. nothing to complain about [...] (BAR 3)
We learn in coexistence and with conflicts, to respect
For those of us who underwent bariatric surgery, to have people’s individuality more, because we normally don’t
good mental health during this pandemic, we would have spend so much time with the family, we spend more
to have the psychological follow-up and talk to other time at work. (BAR 5)
people who had the surgery and who were losing weight It was very nice to spend more time with my son, he used
to encourage us to follow the same healthcare [...] (BAR 5) to complain that I worked a lot. I was now able to pay
To improve my mental health, we would have to get more attention and stay at home more. (BAR 7)
vaccinated soon [...] (BAR 8)
Housework during the pandemic
Based on the thematic analysis of the interviews, we The division of household tasks was a conflicting aspect
highlighted the themes influencing mental health that most during the pandemic, as patients oversaw most of the household
appeared during the patients’ speech. For this purpose, we tasks. Although husbands and children took turns for a few
used the word cloud, which organizes the themes from largest moments to contribute to the organization of the house and
to smallest, based on the frequency of appearance during the avoid family conflicts during this period of isolation, patients
speeches, as depicted in Figure 3. were the most burdened.

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ORIGINAL ARTICLE

[...] it was more difficult to share some household chores, opportunities for relaxation and entertainment helped overcome
but everyone helped with the tasks such as cleaning the this moment of social isolation.
house and washing the dishes. (BAR 2)
I always do the household chores; the only help was with Technology was very good in quarantine, it saved a lot
taking care of the baby (daughter). (BAR 3) of people. If we did not have the technology, I think a
The household tasks were almost entirely done by me, lot of people would have been in a worse mental health
like washing the dishes, washing clothes, cooking, going situation. (BAR 10)
up and down stairs, and only the cleaning was done by
my daughter. (BAR 4) Technological advances related to surgical techniques
were topics mentioned by the patients.
Family leisure activities
During this period of quarantine, few patients had the Technology favors us a lot these days, surgeries are a
opportunity to perform leisure activities. Two patients reported great example of this technological advance, made by
that they conducted recreational activities at home, such as video, several surgeries are not as invasive as they used
board and active games. to be with large cuts. An example of this advance is our
bariatric surgery. (BAR 12)
We invented some leisure activities to do at home, like
board games. (BAR 1) Technology and sedentary behavior
[...] we play “monopoly,” do pillow fights, and watch Sedentary behavior was an aspect that increased during
movies. (BAR 2) this period of isolation at home. Many patients reported that
staying at home and spending more hours using technology
Figure 4 presents the most discussed topics in interviews with favored this increase in a sedentary lifestyle.
women undergoing bariatric surgery. For the subtopic adapting
lifestyle behaviors and social relationships during quarantine, Unfortunately, people are overusing technology and
topics such as family, friends, speech, and time were highlighted. increasingly becoming sedentary. There is no more
interaction and contact with other people, as in the
Innovative solutions for health through technology past. (BAR 1)
in the pandemic The fact that staying at home for a long time made us
more sedentary, we spent most of the time sitting and
The importance of technology and telemedicine for health watching television. (BAR 2)
care in quarantine I believe it is a possibility to do physical activity because
Telemedicine was a very effective quarantine tool for the sometimes we can’t pay a professional to do exercise, and
treatment and health care of patients who had had bariatric we get sedentary, and we get old, our body is a machine
surgery. This support was essential in terms of treatment and if you don’t take care of it, it will rust. (BAR 6)
guidance after bariatric surgery.
Technology and obesity
I had several medical consultations via WhatsApp, which Another topic mentioned by bariatric patients was the
was very important. (BAR 1) increase in obesity and its association with the misuse of
I think telemedicine can be good, over the phone the technology. However, the ease of buying and ordering fast food
simplest needs can be addressed. Although, if the health through apps, increased screen time (computer, cell phone,
situation requires more detailed care, it has to be in person, television), and physical inactivity factors contribute to this
it needs medical contact and physical exams. (BAR 5) deleterious effect on technology-related obesity.
I think we can take care of health through technology.
I like to research and use apps that inform us about the I think technology can increase obesity, because people
questions we have about health. (BAR 6) spend a lot of time sitting and eating a lot of fast foods, in
I would like to have telemedicine with the Rheumatologist addition to spending a lot of hours on the internet. (BAR 2)
to take better care of my health. (BAR 9) For me, obesity can be a person’s genetics or if they tend
to put on weight because there are people who spend all
The use of technology favored the mental health care day at the computer and with a lot of food and don’t get
of many bariatric patients during quarantine. In addition, fat, so I think it has nothing to do with technology. (BAR 3)
It can help in my health, in the fight against obesity,
so that people don’t stand still and avoid more health
problems. (BAR 5)
Technology favors and at the same time, it has disadvantages,
because people do not know how to use it correctly.
Even in children, who no longer play outside as they
used to, it contributes to the increase in obesity. (BAR 6)
I believe it can influence obesity, because people use their
cell phones and television a lot, in addition to sitting and
eating all the time, which will favor weight gain. (BAR 7)
Currently, we have a lot of diet and care information
on the internet, which can help in the fight against
obesity. (BAR 11)
Technology can be used to favor and harm health. As an
example, in this quarantine people watched more television
and videos, and spent more time sitting. On the other
hand, many people posted gymnastics videos and moved
Figure 4 - Social relationship word cloud. more, favoring weight loss. (BAR 12)

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 IMPACT OF THE COVID-19 QUARANTINE ON THE MENTAL AND EMOTIONAL HEALTH OF POST-BARIATRIC SURGERY WOMEN: A QUALITATIVE STUDY

Technology as a tool for adherence to physical activity The word cloud in Figure 5 demonstrates that technology
Social media, videos, apps, and information on the Internet may be relevant to improve physical activity practices at home
may favor the practice of physical activity. Technology may and to post-surgery health-care follow-up.
provide effective tools to promote physical activity, as highlighted
by the patients.

Technology favored patients who had bariatric surgery, DISCUSSION

not only to exercise, but also to help them communicate
with relatives who were far away, with family, and with To the best of our knowledge, this is the first study to
friends, in this moment of isolation. (BAR 2) qualitatively analyze the impact of COVID-19 and lockdown
The technology could help me become more active, measures on the mental and emotional health of post-bariatric
because I can’t maintain regularity of training due to patients. Our results suggested a negative impact of the COVID-19
schedules, I get home late and I have to do the housework pandemic on aspects of mental and emotional health, such as
and take care of my daughter. So I want to go to the gym increased anxiety, depressive symptoms, fear, stress, and anguish.
in person, but I don’t have time. (BAR 3) Bariatric surgery was, however, a positive aspect mentioned by
The ease of training with the help of technology is good the patients for coping with clinical risk conditions, as obesity
because you can choose the best times, and it doesn’t was reported as a high-risk factor for mortality from COVID-19
interfere with your other activities during the day, which since the very beginning of the pandemic. Moreover, being able
helps me to stay active. (BAR 5) to spend more time with the family and carrying out leisure
It would be great for me to do exercises through technology, activities were highlighted as positive aspects, whereas social
to be able to choose a time, and then I would commit, distancing and the division of household chores were reported
because without the commitment I know I won’t do it. as negative aspects. In addition, our patients reported that
That way, it could help me become physically active because technology was an innovative solution for health care through
I know how much time I have and the commitment to the delivered information and telemedicine, thus helping with
wake up at that time. (BAR 7) post-surgery follow-up treatment. It also served as a potential
Through technology, we can become more physically tool for a more active lifestyle as well as an instrument for
active and take better care of our health as well. (BAR 12) home-based exercising. However, they reported that excessive
time spent using technology could be negatively associated
Technology, motivation, and supervision professionals for with an increased sedentary lifestyle and obesity25.
the practice of home-based exercises The negative feelings reported by patients, such as increased
With the restrictions imposed by the COVID-19 pandemic, anxiety, depressive symptoms, fear, stress, and anguish, had a
places for physical exercising, such as public squares and gyms, significant impact on the mental and emotional health of bariatric
were impossible to utilize. In this context, a viable and effective patients16. These results corroborate the findings reported in
alternative was the use of technology to perform supervised the general population2,7 and those of Walędziak et al.36, who
home-based exercises. specifically reported a high level of anxiety in post-bariatric
surgery patients. In addition, limited access to medical and
As the gym closed and I was undergoing a weight loss health care resulting from the quarantine lockdown resulted
procedure, I couldn’t stand still. I started doing exercises in a significant increase in anxiety levels and a deterioration in
at home, like Zumba, using technology. (BAR 2) bariatric surgery outcomes, such as weight loss4,16.
I am not motivated to do online exercises alone; however, In our study, the uncertainty of the consequences of COVID-
if it were on a video call, I would feel more motivated 19 after the surgery was mentioned as a contributing factor by
because someone would be looking at me, talking to me, some patients, as they were told that their immunity could be
and motivating me. Moreover, having the supervision of impaired. Moreover, lockdown measures and deprivation of
a Physical Education professional would make me feel contact with friends and family members also played a major
safer. (BAR 3) role. Notably, being close to family members had opposite
I really like to use technology to practice home-based effects: although it minimized feelings of anxiety in some
exercises. My daughter and I exercise online whenever patients, it increased the feeling of fear and anguish in others
possible. I would like to practice home-based exercises due to the fear of contaminating them. This was probably a
under the online supervision of a professional. (BAR 5) relevant factor in this study because three of the patients were
It is viable to exercise at home. Technology can make health professionals working at the frontline.
it easier, but you need a professional to guide you Obesity was, since the very beginning of the pandemic,
because sometimes you can feel some pain during associated with an increased risk of the disease course of
the exercise and if you are being accompanied by a
professional you will know what to do at that moment.
(BAR 6)
I enjoyed doing home-based exercise through an app
I downloaded; my leg was no longer sore; the exercise
was effective. But I prefer to go to the gym because I
can have the supervision of a professional and other
people exercising. I don’t have the discipline to train
alone. (BAR 8)
Training at home would be easier, being able to choose
the time, I think I could become more physically active
as well, I would feel motivated, and it could help with my
physical and mental health. (BAR 9)
It would be great to have a professional encouraging
you and showing you how to exercise because it’s not
the same thing to train alone. (BAR 10) Figure 5 - Health technology word cloud.

ABCD Arq Bras Cir Dig 2025;38:e1878 7/9

ORIGINAL ARTICLE

COVID-191,38. As such, many patients appreciated the importance due to lockdown measures, which led to social isolation and
of bariatric surgery and the associated weight loss with the an increased burden with household chores. However, bariatric
prevention of potential disease aggravation in the case of surgery was mentioned as a positive aspect of coping with
COVID-19 infection. Interestingly, despite the lack of scientific clinical risk conditions. In addition, for some patients, the
evidence, others believed that the intake of vitamins associated quarantine did provide the opportunity to spend more time
with the surgery was also a preventive factor for coping with with children, spouses, and OFMs.
the COVID-19 pandemic. Future studies should investigate whether the negative
Lockdown measures were one of the biggest social and impacts of the pandemic on the mental health and well-being
emotional challenges for the population in general4,27, which can of this population persist over time, as well as possible therapies
be extended to our sample of bariatric patients. They reported to lessen them.
having been very careful in maintaining social distancing and
following sanitary recommendations. Notably, to some patients,
the lockdown provided an opportunity to spend more time with
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