Arab Gulf Obesity News visited Dr. Osama Al Sanea Exploring his opinion about bariatric surgery practice


Q: Kindly introduce yourself to our readers
A: I am a general surgeon who did his training between Saudi and the United States where I spent 8 years completing several subspecialties in areas of interest to me. My main training focused on minimally invasive surgery as I thought it was the way we would do surgery in the future reducing patient discomfort. I did a fellowship in oncology which focused on research and clinical disciplines where the majority of the practice focused on multimodality treatment but surgery remained the cornerstone in oncology with emphasis not only on lessening the impact of loss of resected organs which included reconstructive surgery that aimed at restoring normality to the human body. Major emptyasis was on breast and head and neck in my oncology fellowship and maintaining an esthetically desirable breast or ability to eat and speak through the mouth as a natural orifice was a subject in evolution at my training. Combining the experience of many mentors helped me to progress my practice towards the concept of a holistic approach to illness. I remember the value of doing a total ladyngopharyngectomy and constructing the first speech valve for a patient 12 years ago who is alive and well today. I took my knowledge of a comprehensive approach to diseases into all areas that I have tackled including bariatric Surgery which I look at as more than a simple medical disease state as I will elaborate in my next answer.

Q: why did you decide to specialize in BariatricSurgery, what attracted you to the specialty
A: When I did my laparoscopy fellowship at New England Medical Center, a major center that has been pioneer even during the pre-laparoscopic with Dr, Bennoti, I noticed during follow up that every patient had a lengthy story behind his or her struggle and some of them shared it as a source of pride for succeeding to get sure from illnesses or just simply to be able to get control on their ambulation while some of them shared the difficulty to adapt to the new change or expectations expectations from them. It was a new area to research, and develop as it was in its infancy. Procedures were being standardized and understanding the pathophysiology of weight loss and its impact on the human body whether in nutritional changes, comorbidity resolution, prevention of disease as well as on appearance became work in evolution. The need for long term follow up to address obesity as a recurring illness was also intriguing and the encouraged me to contribute further in that field especially as I realized the alarming rising proportion of obese members of our society as a result of globalization.

Q: who have been your greatest influences?
A: I had many great influence including my father who often was fond of details whenever he researched a topic and my mother who taught me discipline and perseverance. Through my surgical career, I found mentors shaped me into who I am now. Dr. Michel Lewis the famous plastic surgeon at New England Medical influenced me in going back to the basics and goals of any intervention while Orlo Clark from UCSF in California emphasized the importance of researching every case thoroughly. Many other mentors helped me shape my personality and I owe it to all of them. Yet, my greatest influence were my patients. Their interaction with me and the experience I gained from dealing with them helped me become who I am today.

Q: How do you see the Bariatric Surgery Practice in the Arab Gulf region?
A: I do not know of any other treatment in the history of medicine that was capable of transforming a patient life clearing almost all diseases, restoring health and optimizing the quality of life plus improving the physical appearance, social and psychological well being after a one hour procedure. Bariatric Surgery extended its
patients to include those with metabolic diseases regardless of weight. The Gulf region has been instrumental in the development of bariatric surgery because of the high prevalence of obesity and chronic illnesses. The financial incentive has pushed many hospitals and surgeons to practice bariatric surgery due to the introduction of new easy to learn procedures and advanced technology that reduced complications making it one of the safest procedures in laparoscopy. The issue of oversight and regulation has become a necessity to protect patients from unsafe practice especially in the era of tough economic times where cost cutting might take precedence over the quality of practice on short term basis I Yet, many issues are likely to emerge including weight regain or long term adverse events that require centers of excellence to guard patient safety.

Q: what are the challenges facing Bariatric & Metabolic Surgeons over the nextdecade?
A: There are three main challenges: The first is to limit procedures to those that have been accepted by the international societies as standardized procedures and allow experimental procedures under IRB protocols. This is a task for the national societies to adopt practice guidelines. The second is to provide access for patients who need the surgery as initial upfront cost might be prohibitive for many third party providers and the surgeons need to work across the aisle with their counterpart societies and associations to show the safety of bariatric surgery and the impact it carries on individual health and society economics. The third challenge is to educate the entire medical community in the after care of bariatric patients and this must include follow up, recognition of problems and identifying the patients who need assistance in specialized bariatric centers.

Q: Who should perform Bariatric Surgery
A: Bariatric surgery represents the most technically challenging form of Laparoscopic surgery. Experience and advanced technical skills are a must. Knowledge of the pathophysiology of obesity and a comprehensive team remain pivotal to the success of each surgeon and until bariatric medicine and surgery become part of the core education an draining in medial school, the burden will remain on the surgeon to ensure patients are well taken care of and properly followed.

Q: Away from Surgery, how do you relax?
A: Surgeons are trained to put their practice and patients as the focus of their attention throughout their careers. In solo private practice, this is worse as the preoccupation with patients joins the surgeons even as he sleeps. The stress of a sick patient post op often overwhelms a caring surgeon. As I get older, prayer and spending more time on spirituality gave me the comfort in realizing my shortcomings as a human being and not to ask of myself more than I can do so being content helped me relax bit, but watching my children grow and become successful, spending more quality time with my wife has helped me tremendously relax and to be content and happy with where I am in my life journey. I still like to read and I find great joy in new knowledge. I do not exercise as I used to do but I have replaced it with brisk walking at the end of the day. Appreciating the little things in life is an art that I never had as a busy surgeon. I am just more composed and not in a hurry any more.






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