Bariatric News spoke to Professor Oral Ospanov (Professor of Medicine and Surgery, Head of Department of Laparoscopic & Bariatric Surgery at Astana Medical University, in the Republic of Kazakhstan) about his career, the current status of bariatric surgery in Kazakhstan and his FundoRing OAGB procedure…
Did you always want to enter medicine, did you ever aspire to be anything else (architect, engineer etc)?
Before entering medical university, I wanted to become a mechanical engineer, because I always love technology and cars. And I chose medicine because when I served in the army, I went to military medical training. There I learned what medicine is and have loved it ever since.
Why did you decide to specialise in bariatric surgery?
When I was in Berlin at a medical conference, I became interested in a field of medicine about which I knew little. And I completed postgraduate course “Bariatric surgery” in Berlin.
Who have been your greatest influences and why?
In medicine, my greatest influence as a bariatric surgeon was Henry Buchwald and his research in metabolic surgery.
What experience in your training/career has taught you the most valuable lesson?
One of the patients in whom I performed one anastomosis gastric bypass surgery in 2012 complained that she had suffocation at night because bile entered her respiratory tract and she almost suffocated. And since then, I began to think about how to improve this operation. What led me to develop the “FundoRing OAGB” method.
What are the current levels of obesity in the Kazakhstan?
According to the Public Health Center of Kazakhstan, more than 20% of Kazakhstanis are obese. And every year the number of people with obesity in Kazakhstan is growing.
How many bariatric centres and surgeons are there in the Kazakhstan?
There are about 15 officially practicing bariatric surgeons in Kazakhstan. And one Сenter for obesity and diabetes surgery based at the Green Clinic, Astana. According to our estimates, in 2022, a little more than 1000 bariatric procedures were performed. Among all types of operations, MGB is in 1st place. In second place is sleeve resection and in third place is Roux-en-Y gastric bypass.
What is the current healthcare coverage (access to surgery) for bariatric surgery in Kazakhstan?
We can say that at the moment bariatric surgery is not available to everyone. The vast majority of operations are performed for a fee, that is, at the patients’ own expense. The insurance benefits offered by the Ministry of Health do not cover the costs. Therefore, clinics do not carry out these operations under insurance, only on a paid basis. Many patients save money for a long time or take out loans for surgery. At the moment, we are working together with the Health Insurance Fund to raise the cost of these operations so that they can be carried out under insurance. That is, make it more accessible.
What do you believe should be done to encourage more patients to come forward for surgery (eg. education on the safety and effectiveness of surgery)?
In order for patients to see surgeons more often, I think we must first work with the community as a whole. In our country, obesity surgery is something new and unknown to ordinary people and even to doctors. What can we say about an ordinary lamp, if even many doctors or even the majority do not know what bariatric surgery is and what it is needed for. Many doctors discourage patients, still fearing that it is unsafe, simply because they are not fully informed. In our country, the number of people with obesity and type 2 diabetes is growing. They first seek treatment from internists, general practitioners and endocrinologists. And these doctors should offer various treatment options, including surgery. The 2nd Congress of Bariatric and Metabolic Surgeons of Kazakhstan, which took place on September 29, 2023, is focused on the joint work of an endocrinologist and a surgeon. We are trying to inform the medical community and work together.
What are the biggest challenges currently facing bariatric surgeons in Kazakhstan and over the next ten years?
I think the biggest challenge for bariatric surgery in Kazakhstan is the acceptance of this trend in the medical community and overcoming the stigma that may arise in society. But the more we practice and educate the public, the more people and doctors realize that it really does help patients. I think we are moving in the right direction.
For example, from 27-29 September 2023, we held the Second Congress of Bariatric and Metabolic Surgeons of Kazakhstan - KaSBariMeT-2023. The main topic of this congress was the surgical treatment of type 2 diabetes mellitus in the practice of a surgeon and endocrinologist. The goal of our congress was to unite bariatric surgeons and endocrinologists to more effectively treat type 2 diabetes mellitus. For our community, for bariatric surgery in general and for endocrinologists in Kazakhstan, this was a historical event. Because we have adopted the Consensus between bariatric surgeons and endocrinologists on the surgical treatment of type 2 diabetes mellitus. This is a great merit to our society and the society of endocrinologists. This will allow us to work together, inform the medical community more and more effectively fight type 2 diabetes mellitus.
You have established the Kazakhstan Bariatric Surgery Registry. Why did you establish the registry and what are the benefits of collecting such data?
Bariatric surgery in Kazakhstan is a relatively new branch of medicine. Therefore, I really wanted this part of the surgery to go the right way from the very beginning. We wanted to understand and see the overall picture of bariatric surgery in our country. What procedures are performed and in what quantity? what quality and result? And in order to have an objective picture of what is happening, we created a bariatric register, looking at the experience of other countries. It was important to understand where we stand and to determine the population's need for bariatric surgery. The benefits we can get from launching the register are enormous. The quality and safety of various types of operations will be assessed. The data will be used for analysis and research, as well as improving the quality of care provided. The data we receive will be reported to the Ministry of Health and the Health Insurance Fund to make appropriate decisions. Ultimately to show the medical community and the public that this is a very safe surgery that can treat many diseases. And overcome the stigma regarding the treatment of obesity and related diseases, which could have formed in our country.
What are your current areas of research?
At the moment, all our research is carried out in the field of bariatric and metabolic surgery. We are studying the long-term effects of surgical treatment of diabetes mellitus and metabolic syndrome. We have also developed our own concept of one anastomosis gastric bypass, which is called “FundoRing OAGB”. The main point is that we combine OAGB and our own method of fundoplication from the excluded part of the stomach routinely during primary operations, which, according to the results of our study, gives us excellent results in preventing the occurrence of reflux esophagitis and biliary reflux. We performed a study and published it in the journal Obesity Surgery (Ospanov O, et al. A Randomized Controlled Trial of Acid and Bile Reflux Esophagitis Prevention by Modified Fundoplication of the Excluded Stomach in One-Anastomosis Gastric Bypass: 1-Year Results of the FundoRing Trial. Obes Surg. 2023 Jul;33(7):1974-1983. doi: 10.1007/s11695-023-06618-y. Epub 2023 Apr 26. PMID: 37099252).
Finally, when you have time away from surgery, how do you relax?
In my free time I try to spend more time with my family. And whenever possible I try to devote time to fitness.