Professor Lilian Kow OAM
BMBS ’85, PhD(Med) ’96
By David Sly
Since her childhood in Malaysia, Professor Lilian Kow OAM knew she wanted to be a surgeon. Now, as a world leader in obesity and metabolic surgery, she reflects on following her curiosity to explore innovative ideas that started at Flinders University.
“As a student in the Flinders medical program, I really benefitted by coming through an unconventional medical school with a very diverse group of students. In the 1980s, it was a new course and there was a quite young faculty. It was a dynamic place of fresh ideas and great possibilities,” she says.
Her journey of specialisation in surgery followed an unconventional path, sparked by her personal interests and inspiration but also her capacity to seize a fresh opportunity.
“I always wanted to be a surgeon because I was particularly interested in the technical aspects of surgery – rather than a dermatologist examining skin, or being a physician that required a lot more brain power than just being hands-on. I’m a practical type of person and have always been good with my hands – I loved playing the piano and playing racket sports – so surgery seemed the natural fit for me.”
Surgical Breakthroughs
Her first area of specialisation was in hepatobiliary pancreatic and liver transplant surgery at Flinders Medical Centre, but her career changed direction in 1996 when laparoscopic adjustable gastric bands were introduced to South Australia.
“We have been doing a little bit of obesity surgery at Flinders because we were only doing about 12 liver transplants each year – and weight loss surgery was a passion of James Watts, the first Professor of Surgery at Flinders, so he made sure we were all involved in some way. Because of that interest, the then GI Surgery Director at Flinders Jim Toouli brought back a new type of an adjustable gastric band that had been invented by a surgeon in Sweden. He suggested we may want to introduce this to Australia, and we gave it a try so that we could study this curious new device.”
It proved a revelation. At that time, the only available obesity surgery was an open gastric bypass, leaving patients with a very large abdominal wound and postoperative pain confining them to bed for at least a week. Inserting the gastric band via laparoscopic keyhole surgery, allowing patients to go home the following day, revolutionised and quickly popularised obesity surgery – even though its introduction was rather dramatic.
“I remember the first surgery we did, and we had Dr Peter Forsall the inventor of the gastric band talking to us over the phone from Sweden, instructing us how to do this operation,” recalls Professor Kow. “Laparoscopic surgery was just starting at Flinders, so we were using instruments that are usually used by the gynaecologists. It was frustrating because we didn’t have specific instruments or refined techniques at that stage.
The first operation took nearly three hours. We now do the same procedure in 20 minutes.”
Innovative Procedure
The success of that first innovative procedure saw Professor Kow and colleagues become pioneers in gastric band surgery and weight loss (bariatric) surgery in Australia, and demand from patients for adjustable gastric band surgery quickly accelerated. “It prompted the start of my private practice – but if you had told me earlier in my career that I would specialise in bariatric surgery, I would have laughed,” says Professor Kow.
It coincided with a global escalation in the concern about obesity. “It was becoming an epidemic – especially in the United States, but we also realised that Australia was not so far behind, being ranked in the top five around the world for the disease of obesity. The successful introduction of gastric band surgery made it easier to have serious conversations about obesity in medical circles and with patients. In Australia, gastric banding surgery increased in popularity for its adjustability and for its minimally invasive approach. Patients with obesity were coming to us and asking for this surgery. We quickly went from doing a few gastric bands a year to about 15,000 bands a year in Australia by 2008. By then bariatric surgery became acceptable as a safe and effective procedure and newer types of surgery have now been introduced and superseded the adjustable gastric bands.”
Professor Kow says working with gastric bands taught her a different type of medicine, and also a different way of dealing with patients. “I learned to manage people with a chronic disease that surgery never taught me. With most surgery the procedure is intended to cure or remove disease and the surgeon doesn’t get to see their patients again. Obesity is a chronic disease, so even after their surgery, we need to continue looking after the patients to provide them with multidisciplinary care. We work with them along their journey to trigger and maintain the crucial changes to their daily lifestyles.”
Women in Surgery
Professor Kow’s expertise placed her in an authoritative position, leading to her joining the Australian and New Zealand Metabolic and Obesity Surgery Society (ANZMOSS), then the International Federation for the Surgery of Obesity and Metabolic Disorders (IFSO). “In groups like that, when a female surgeon came along, they were always asked by the men to be the secretary – because we are the most organised and efficient.” She was so organised that she ended up being the first female president of ANZMOSS, then the IFSO Asia-Pacific chapter, and then the first female president of the World Body of IFSO, from 2019 to 2022.
Without consciously realising the significance of these landmark achievements, Professor Kow was being cited as a female role model. “That surprised me, because it certainly wasn’t something I set out to do, but then I realised the importance of me being recognised for doing the best job that I could,” she says.
“When I was accepted into general surgical training at Flinders, I was told that there had been no female trainee for the previous 20 years in South Australia. The lack of a female role model in Adelaide at that time was obvious.
“I’m so pleased that we now have women surgeons in almost every surgical subspecialty in South Australia and Australia, and that we are being recognised at the highest levels by our peers and across society.”
She now encourages young women to take an active role in advocating for better policies on gender discrimination to be implemented at universities and large professional healthcare institutions. “We can make surgery a better profession not just for women, but for everyone seeking to provide health care in an environment free from discrimination. We don’t think about gender any more, but instead about a person’s capacity to do the job.
“Removing all of the barriers to women in surgery will require fundamental and long-lasting social changes in how people perceive the role of women within society, and increased understanding of the fact that a person’s career opportunities should not be limited by their gender, race or sexual orientation. This will take time.”
For her work, Professor Kow was awarded the Certificate of Distinguished Service in 2011, the ANZ Journal of Surgery Medal in 2023 by the Royal Australasian College of Surgeons, the inaugural International Award by the TREO Foundation of the American Society of Metabolic and Bariatric Surgery in 2023, and the Medal of the Order of Australia in 2022 for her distinguished service in bariatric and obesity medicine.