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When surgery's a no go

Major surgical operations can save lives, but there are times when they are just unnecessary and even potentially harmful.


By Yves Saint James Aquino, M.D.


It may sound extreme, but it’s true: there are people to whom surgery has become the first recourse. Illnesses cause them to get paranoid and their radical solution blurs the line between preventive surgeries and unnecessary ones.


Under the knife

Based on the Code of Ethics of the  Philippine College of Surgeons, improper or inappropriate surgery is “[s]urgery that does not address or resolve the surgical problem at hand,” while unnecessary surgery is “[surgery] without medical indication.”

However, unhealthy life choices have brought with them a host of surgical treatments considered rare or even nonexistent half a century ago. While surgery is a valid option, the possibility that thousands, if not millions, of people go under the knife for surgeries they don’t need is a chilling thought. They endure great pain, court post-op complications, break the bank or go into debt, and risk their lives unnecessarily.


Unnecessary operations

Based on studies, the major operations commonly performed that are often deemed unnecessary are:


Cardiovascular surgeries

Surgeries that involve the heart and blood vessels may include pacemaker implants, coronary bypass surgery, and angioplasty. Pacemaker implantation is a procedure to insert a small, battery-operated device, called a pacemaker, into the chest to control abnormal heart rhythms. It is used to treat arrhythmia, a condition where the heart beats too fast, too slow, or irregularly, and can be life-threatening when it results in cardiac arrest or heart attack. In the U.S., a team headed by Dr. Allan Greenspan of Albert Einstein Medical Center in Philadelphia, estimated that 20 percent of pacemaker operations were unnecessary after specialists reviewed the charts of 380 patients who had received pacemakers at 30 hospitals in Philadelphia. One reason was that some physicians failed to evaluate their patients’ symptoms correctly.

Similar studies done with coronary bypass surgeries and angioplasty, which are procedures that correct abnormalities in blood vessels, proved that a considerable number of patients where such surgeries were done could have benefited from more conservative or non-surgical treatments.

What you can do: One of the best ways to avoid an unnecessary surgery is to get a second medical opinion. Get as much information as you can from doctors and explore all alternatives to surgery. Inquire about possible medical therapies, as well as diet and lifestyle changes that may help treat the disease.


Caesarean delivery

A Caesarean section, or C-section, is a surgical procedure that allows a baby to be delivered abdominally. It is performed when vaginal delivery puts the baby’s or mother’s life at risk.

An ongoing international survey by the World Health Organization found that in Asia, elected surgical deliveries with no medical indication put both mother and child at greater risk. Cited as common reasons for recommending a C-section include a woman’s having had the procedure before, a fetus in distress, and cephalopelvic disproportion (when the baby’s head cannot fit through the mother’s pelvic opening).

The study, published early this year in the medical journal The Lancet, said unnecessary C-sections increase the risk of maternal death, infant death, admission to an intensive care unit, blood transfusion, or hysterectomy (the removal of the uterus) compared to spontaneous vaginal delivery.

What you can do: Get a regular prenatal check-up to assess the status of your pregnancy and to check if you can deliver your baby vaginally. If a C-section is recommended, ask why. It is no longer advisable to request for a Caesarean delivery if there is no medical indication.


Cataract surgery

Cataract surgery is the removal of the opacified lens of the eye that can cause impairment or loss of vision. In 1993, the U.S. Public Health Service Agency for Health Care Policy and Research stated that cataract surgery is not necessary if glasses or visual aids provide satisfactory vision and the patient’s lifestyle is not compromised. The panel reviewed 8,000 published studies on cataract care, with additional information provided by consultants and specialty societies, among others. According to the panel’s clinical practice guidelines, Cataract in Adults: Management of Functional Impairment, patients and ophthalmologists should consider stronger glasses, magnifying lenses, pupil dilation, or delay until the cataract becomes more burdensome.

What you can do: When you suspect you have cataracts, avoid eye specialists whose practice consists mainly of cataract surgery. If a doctor recommends surgery, get a second opinion. Remember: for as long as the cataract doesn’t hamper your daily activities, you may still avoid or delay going under the knife.

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