That Surgery You’re About to Have: How Necessary Is It?

New studies show that removing the appendix, tonsils and more are worth a second thought

Maybe you don’t need your appendix out after all.

Sailors caught in the middle of the ocean with appendicitis have been treated with antibiotics only. Socialized health care systems have also, at times, had so many people coming in with the same issue that after doctors tided them over with antibiotics — the patients got better.

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A Finnish study reached that conclusion, too, in 2015, prompting experts at Southampton Children’s Hospital in Hampshire, England, to launch their own study a year ago. The results are in and it’s true: Treating acute appendicitis with antibiotics can be just as effective as surgery. And operating on children may be unnecessary in many — if not most — cases.

“As a pediatric ER nurse of 20 years ago, [surgery] was fairly standard operating procedure,” said Twila Brase, R.N., co-founder of the Citizens’ Council for Health Freedom, a national patient-centered organization in St. Paul, Minnesota. “The real danger is a ruptured appendix, which could lead to peritonitis when abdominal contents are spilled into the gut. That can be life-threatening.”

Even if surgery isn’t necessary, people are busy and in a hurry, she said. And if there is a procedure that seems like a quick fix, people are more likely to want it.

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“Given how long surgical intervention has been in the public’s mindset, people may disagree with a non-surgical intervention or find it scary to wait. This is why a strong relationship with a physician, and sufficient time with patients [on the doctors’ part], is critical to reducing the need for expensive or unnecessary interventions,” Brase told LifeZette.

Information to support the notion that certain surgeries may be “unnecessary” is relatively new, said Michael Russo, M.D., a general surgeon specializing in bariatric surgery at MemorialCare Center for Obesity at Orange Coast Memorial Medical Center in Fountain Valley, California. Any science to back up that a surgery is needed or not needed should strongly be considered by patients, he added. Those told they need a stent, pacemaker, spinal fusion, prostatectomy, gallbladder removed, knee replacement, cosmetic surgery, carpel tunnel release, ear tubes, fallopian tubes tied, tonsils out — or even a mastectomy — might want to get a second opinion.

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Surgery for a hernia also very much falls into this category, Russo added.

“What the data suggests is it’s actually OK to watch and wait. If someone’s quality of life is being negatively affected, then surgery is a great option. If someone is not really having any issues, or if they’re medically ill or elderly, then [an issue] probably doesn’t need to be repaired and the risk of any problems is probably pretty low,” he noted. “You don’t need to fix a hernia just because it’s there.”

Despite his role as a surgeon, Russo said he is a proponent for studies that show there may be better non-surgical options for patients.

“The reality is that surgery, no matter how good you are or how minimal it is, hurts someone. The key that a surgeon and patient must decide is whether the small amount of injury that you’re causing is going to lead to the patient ultimately having a higher quality of life and a better result. That’s the ultimate surgical decision-making quest,” he emphasized.

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Brase agreed with that assessment. “When we are sick or injured and need the best possible medical care, there are amazing surgical interventions for conditions in which there is no other option for treatment. And thankfully surgical intervention is increasingly less invasive. But there are many conditions that could be corrected with non-surgical interventions.”

Questions to ask before anyone agrees to surgery, said Brase, include these five:

1.) Is the surgery necessary?

2.) Is there an non-surgical alternative?

3.) What are the possible complications from surgery, and from waiting to have it?

4.) Which option includes higher risks?

5.) How long can we wait before we need to make a decision about surgery?

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