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Minimize Elective Surgeries, Say Experts

by Gopalan on July 29, 2007 at 1:06 PM
Minimize Elective Surgeries, Say Experts

Some experts in US seem to feel that it would be best to minimize elective surgeries.

Elective surgery is something that is considered not essential, especially surgery to correct a condition that is not life-threatening; surgery that is not required for survival.


Hysterectomy, angioplasty, episiotomy, lower-back surgery and heartburn surgery are among the more popular surgeries one could avoid. Instead opt for relatively less invasive procedures, they say.

Writing in the Health magazine, Curt Pesmen quotes the Journal of the American Medical Association as saying that at least 12,000 Americans die every year from unnecessary surgery. And tens of thousands more suffer complications.

For instance, American women undergo twice as many hysterectomies per capita as British women and four times as many as Swedish women. Hysterectomy is removal of uterus.

The surgery is commonly used to treat persistent vaginal bleeding or to remove benign fibroids and painful endometriosis tissue.

Fibroids are benign tumours, which grow from the smooth muscle in the wall of the uterus. They are not cancers. Heavy menstrual bleeding and a feeling of pressure in the pelvis are some major symptoms of the problem.

Endometriosis is a common medical condition affecting an estimated 89 million women of reproductive age around the world.

In endometriosis, the tissue that lines the uterus (the endometrium, from endo, "inside", and metra, "womb") is found to be growing outside the uterus, on or in other areas of the body.

Normally, the endometrium is shed each month during the menstrual cycle; however, in endometriosis, the misplaced endometrium is usually unable to exit the body. The endometriotic tissues still detach and bleed, but the result is internal bleeding, degenerated blood and tissue shedding, inflammation of the surrounding areas, pain, and formation of scar issue may result.

In addition, depending on the location of the growths, the normal functioning of the bowel, bladder, small intestines, and other organs within the pelvic cavity could also be affected.

When both the uterus and ovaries are removed, as in hysterectomy, it takes away sources of estrogen and testosterone. Without these hormones, the risk of heart disease and osteoporosis rises markedly. There are also potential side effects: pelvic problems, lower sexual desire and reduced pleasure.

Hysterectomies got more negative press after a landmark 2005 University of California, Los Angeles study revealed that, unless a woman is at very high risk of ovarian cancer, removing her ovaries during hysterectomy actually raised her health risks.

So why are doctors still performing the double-whammy surgery? Simply it has become a habit with surgeons. Almost 75 to 85 per cent of hysterectomies performed in US are unnecessary, feels, Ernst Bartsich of the Weill-Cornell Medical Center in New York.

Endometrial ablation, a non-surgical procedure that targets the uterine lining, is another fix for persistent vaginal bleeding.

Also myomectomy, which removes just the fibroids and not the uterus, is becoming increasingly popular.

Using injectable pellets that shrink and "starve" fibroids into submission by blocking blood supply to fibroids. and a no-scalpel surgery that combines MRI (an imaging machine) mapping followed by powerful sound-wave "shaving" of tumor tissue are among the other alternatives suggested.

Episiotomy involves cutting or extending the vaginal opening along the perineum (between the vagina and anus) to reduce the risk of pelvic-tissue tears and ease childbirth.

But studies show that severing muscles in and around the lower vaginal wall (it's more than just skin) causes as many or more problems than it prevents. Pain, irritation, muscle tears, and incontinence are all common aftereffects of episiotomy.

Last year the American College of Obstetricians and Gynecologists released new guidelines that said that episiotomy should no longer be performed routinely.

The Kegels exercises, for stronger vaginal muscles or performing perineal and pelvic-floor massage before and during labor could be better options.

Angioplasty is another surgery widely practiced. Every year in the United States, surgeons perform 1.2 million angioplasties, during which a cardiologist uses tiny balloons and implanted wire cages known as stents to unclog arteries. This is of course less invasive and has a shorter recovery period than bypass, which is open-heart surgery.

But a groundbreaking study of more than 2,000 heart patients indicated that a completely nonsurgical method -- heart medication -- was just as beneficial as angioplasty and stents in keeping arteries open in many patients.

"If you have chest pain and are stable, you can take medicines that do the job of angioplasty," says William Boden, of the University of Buffalo School of Medicine, Buffalo, New York, and an author of the study. Medicines used in the study included aspirin, and blood pressure and cholesterol drugs -- and they were taken along with exercise and diet changes.

Of course, what's right for you depends on the severity of your atherosclerosis risks (blood pressure, cholesterol, triglycerides) along with any heart-related pain. The onus is also on the patient to treat a doc's lifestyle recommendations -- diet and exercise guidelines -- just as seriously as if they were prescription medicines.

A whopping 60 million Americans experience heartburn at least once a month; 16 million deal with it daily. A procedure called nissen fundoplication can help control acid reflux and its painful symptoms by restoring the open-and-close valve function of the esophagus.

But Jose Remes-Troche of the Institute of Science, Medicine, and Nutrition in Mexico, reported in The American Journal of Surgery that symptoms don't always go away after the popular procedure, which involves wrapping a part of the stomach around the weak part of the esophagus.

"That may be because surgery doesn't directly affect healing capacity or dietary or lifestyle choices, which in turn can lead to recurrence in a hurry," he says. The surgery can come undone, and side effects may include bloating and trouble swallowing.

Instead one can decide to go for lifestyle changes. A combination of diet, exercise, and acid-reducing medication may help sufferers overcome the problem.

"It took me four years of appointments, diets, drugs, sleeping on slant beds -- and even yoga -- to keep my heartburn manageable," says Debbie Bunten, 44, a Silicon Valley business-development manager for a software firm, who was eager to avoid surgery. "But I did it, and am glad I did."

Another technological development can make a heartburn diagnosis easier to swallow -- a tiny camera pill that beams pictures of your esophagus (14 shots per second) through your neck to a receiver or computer in the doctor's office; it passes harmlessly out of your system four to six hours later. The device can be used instead of standard endoscopy to screen chronic-heartburn sufferers for various esophageal complaints.

Finally, the lower-back surgery. Since the 1980s, operations for lower-back pain and sciatica have increased roughly 50 percent, from approximately 200,000 to more than 300,000 surgeries annually in the United States.

Sciatica is sometimes severe pain caused by general compression and/or irritation of one of five nerve roots that are branches of the sciatic nerve that runs down the lower limb. The pain is felt in the lower back, buttock, and/or various parts of the leg and foot. In addition to pain, there may be numbness, muscular weakness, and difficulty in moving or controlling the leg.

To its credit, surgery (endoscopic or the traditional lumbar-disc repair) does relieve lower-back pain in 85 to 90 percent of cases, docs say. "Yet the relief is sometimes temporary," says Christopher Centeno of Colorado.

Try painkillers and exercise. Despite the relentless nature of lower-back pain, the most common cause is a relatively minor problem -- muscle strain -- not disc irritation, disc rupture, or even a bone problem, experts say.

Despite its severity, this type of spine pain most often subsides within a month or two. That's why surgery, or any other invasive test or treatment beyond light exercise or painkillers, is rarely justified within the first month of a complaint. Even pain caused by a bulging or herniated disc "resolves on its own within a year in some 60 percent of cases," orthopedists claim.

Source: Medindia
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