Year 2017 statistics on bariatric surgery in Estonia.

Altogether 718 bariatric operations were performed last year by 8 different hospitals. Most frequently performed surgery  was sleeve gastrectomy (49%) followed by standard gastric bypass (38%). Mini gastric bypass (5%), revision surgery (5%), laparoscopic gastric banding (2%) and gastric plication (1%) accounted 13% of all surgeries.

Bariatric Services teamDr Ilmar Kaur and Dr Priit Miidla – performed 302 weight loss surgeries in 2017. That makes them the team that performs the largest number of bariatric  operations in Estonia, Baltics and Finland.

How long have bariatric surgeries been perfomed in Estonia?

The era of modern (laparoscopic) weight loss surgery in Estonia started at North Estonian Medical Centre in Tallinn, where in 2004 first laparoscopic gastric band was placed, followed by first laparoscopic gastric bypass and sleeve gastrectomy operation in 2005.

During following years weight loss surgery in Estonia entered into the phase of exponential growth when numbers of surgeries increased from 7 in 2005 to 677 operations in 2013.
Thereafter annual number of bariatric surgeries plateaued at 700 surgeries per year. It is comparable to yearly number of weight loss surgeries in Denmark (700) and in Finland (920 surgeries in 2016).

From 2004 to 2017  a total of 5018 bariatric surgeries have been performed in Estonia.

How popular is bariatric surgery in Estonia  compared to neighbouring countries?

When we look at the number of surgeries per 1 million, then Estonia stands out as one of the leaders in the region with 560 surgeries. This is comparable with Norway (566) and Sweden (565) and surpassing considerably Finland (166), Denmark (125) or UK (76).

Undoubtedly one of the reasons behind fast development of bariatric in Estonia has been fairly generous public financing of surgeries by Estonian Health Insurance Fund.
In Latvia and Lithuania, in contrary, the shortage of public reimbursement has kept the absolute numbers of weight loss surgeries 2-3 times lower than in Estonia.

Bariatric surgery received a lot of positive attention in 2013 when Dr Ilmar Kaur was selected as Doctor of the Year in Estonia.

Around 60% of surgeries  are financed publicly, whereas 40% are financed by patients. During recent years, public financing has slightly declined, while the total number of surgeries has remained the same (around 700). Waiting time for publicly financed weight loss surgery (after surgeon’s appointment to surgery) is between 18 and 24 months.

Increasing number of private patients, financing their surgeries by themselves, come from other countries.

What is the medical and safety level for bariatric surgery in Estonia?

Dr Ilmar Kaur, chairman of Estonian Society for Bariatric and Metabolic Surgery, notes that Estonia is increasingly attractive for weight loss surgery patients from Nordic countries and UK – countries where patients experience very high standards of healthcare. It is an acknowledgment of the excellent performance of Estonian bariatric surgeons and Estonian health care system.

More than 80% of bariatric surgeries in Estonia are performed by four major bariatric centres, each of which performs yearly more than 100 surgeries. This consolidation enables to perform better and safer weight loss surgeries.

In co-operation between ESBMS and Estonian Health Insurance Fund, a practical treatment guidelines and standards of care for bariatric surgery were issued in 2016.

During years 2004-2017 perioperative 90-day mortality has been 0,1%. Rate of serious complications requiring emergency surgery was 1,1% in 2017.
These Estonian bariatric surgery figures are comparable with statistics of Scandinavian countries. From international perspective, weight loss surgery quality in Estonia can be considered as very high.

What are the most common operation methods in Estonia?

Historically, in Estonia the prevalent methods of bariatric surgery have been standard gastric bypass and sleeve gastrectomy.

During 2004-2017, 65% of all weight loss surgeries were gastric bypasses, followed by gastric sleeve (33%). However, the share of gastric sleeve has increased year by year and in 2017, for the first time, gastric sleeve operations exceeded gastric bypass operations.
Same trend is witnessed in most countries of Europe and in USA. Main reasons for increase of gastric sleeve operations are better standardisation of surgical technique, resulting in better and more sustainable weight loss, also patients’ perception of sleeve as more natural procedure.

Dr Kaur adds that gastric bypass surgery still remains the golden standard in bariatric surgery, while newer methods are compared with gastric bypass. Vast experience, scientific data and excellent long term results make gastric bypass a cornerstone of weight loss surgery.

Summary

In summary – bariatric surgery in Estonia is well established and organized health care service. Number of surgeries per capita is amongst the highest in the world.
High institutional and individual experience of physicians warrants safe and quality surgery which has also resulted steadily growing number of foreign patients seeking for bariatric surgery in Estonia.

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