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Bariatric surgery in…

…Russia

Bariatric surgery in Russia is safe and the number of procedures is increasing according to data from the Russian National Bariatric Registry.

Drs Alexander Kuzminov (left) and Bekkhan Khatsiev, co-authors of the paper.

Russia has a population of 142.9 million and according to the 2005 Russia Longitudal Monitoring Survey, 31% of the population are overweight with 22% reported as obese, said Dr Bekkhan Khatsiev, Stavropol State Medical Academy, Russia, who presented the data at the IFSO-European Chapter, in Barcelona, Spain. Russia has also seen an increase in the numbers of patients treated for obesity, from 470,000 in 1994 to 665,000 in 2005 (40% increase). Over this period, the percentage of the population reported as overweight has remained stable at around the 30% mark, although the percentage of the population reported as obese has steadily increased from 19 to 22%.

The Society of Bariatric Surgeons of Russia was established as official organization and a member of IFSO in 2000 and has held 11 annual Moscow workshops on obesity surgery. “Although Russia now boasts 83 bariatric surgeons, we are still some way behind other nations in terms of the number of surgeons and number of bariatric clinics [48],” Khatsiev said. “More importantly, we are also significantly behind in the numbers of procedures performed each year.”

Citing data from the Russian National Bariatric Registry, which collected data from 69 bariatric surgeons (83%), he said that the total number of registered bariatric procedures in 2011 was 989.

Interestingly, more than 50% of these procedures were performed in just two high volume (>100 operations per year) centres both in Moscow (The Clinical Centre of Surgery of Obesity and Metabolic Disorders (387 operations) and the Centre Of Endosurgery and Lithotripsy (113 operations)), with the majority number of procedures (646) performed in the capital, 90 in St Petersburg and 253 in the rest of the country.

The data also reported a low mortality rate following bariatric surgery of 0.3% (three deaths): a stroke following adjustable gastric band; a leakage following sleeve gastrectomy; and pneumonia following BPD.

Procedures

The overwhelming majority of procedures are performed laparoscopically (76.5%), with the remaining (23.5%) performed via a laparotomy. Regarding the type of treatment, adjustable gastric band and sleeve gastrectomy account for more than 70% of all treatments in Russia. A complete breakdown of treatment type is shown in the table below.

Treatment type No. of treatments % of treatment
Adjustable gastric band 367 37.1
Sleeve gastrectomy 335 33.9
Gastric bypass 166 16.8
Duodenal switch 98 9.9
BPD-Scopinaro 9 0.9
Other 14 1.4

Table 1: Treatment type

“Obesity surgery is still not well known in our country, but improvements are evident, although slow,” concluded Khatsiev. “The primary reason for the slow adoption of surgery as a valid treatment option for obesity is heavy resistance from GPs, endocrinologists and general surgeons. Finally, bariatric surgery in Russia costs half an average annual salary so the lack of insurance or state support for bariatric operations influences bariatric surgical activity.”

The co-authors of the paper were Professor Yury Yashkov (The Center of Endosurgery and Lithotripsy, Moscow) and Alexander Kuzminov (Stavropol State Medical Academy, Stavropol).