Many adults remember having their tonsils removed; from the 1930s through the 1960s, childhood tonsillectomy was common. Doctors today favor a more conservative approach, believing that for most children tonsillectomy may offer more risks than benefits. On the other hand, adults who still have their tonsils and suffer from frequent sore throats may well benefit from having their tonsils removed. A study of 83 adults undergoing tonsillectomy found that their quality of life improved significantly over the next 38 months. They had fewer days lost from work, fewer physician visits and a decrease in the number of weeks they had to take antibiotics. The annual cost savings was estimated at $1,275 per patient. 
[SOURCE: Sharon Worcester, "Adult Tonsillectomy," Internal Medicine News," January 1, 2003]

Avoid These Supplements Before Surgery
                                                                                   

Some dietary supplements can increase the risk of complications during surgery. Surgical patients should report to their doctor all supplements they are taking and discuss which ones should be discontinued and when.

Garlic, gingko, ginseng and St. John’s wort, for example, increase the risk of bleeding and should be discontinued at least a week before surgery. Prolonged use of echinacea can suppress immunity and result in poor wound healing. Kava and valerian intensify the sedative effect of anesthesia. Ma huang creates an elevated risk of heart attack.
[SOURCE: Catherine Golub, “Ready Yourself for Recovery: Tips for Pre- and Post-Op Nutrition,” Environmental Nutrition, November, 2001.]

Avoiding After-Effects of Surgery
                                                                                               

Complications involving the brain and central nervous system are among the most troubling after-effects of heart bypass surgery. The most serious of these, affecting 3 to 6 percent of patients, include stroke, transient ischemic attacks (or min-strokes) and coma. Less severe impairments of memory, attention, concentration and thinking occur in 20 to 80 percent. For some patients, major deficits may last as long as five years after surgery. Studies show that those most likely to suffer lingering problems are patients showing symptoms soon after the surgery. Many doctors believe that beating heart or off-pump surgery can bring about a reduction in neurological after-effects. Research to date, however, has been inconclusive on this matter. 
[SOURCE: Vipin Zamvar, et al, "Assessment of Neurocognitive Impairment after Off-Pump and On-Pump Techniques for Coronary Artery Bypass Graft Surgery: Prospective Randomised Controlled Trial," British Medical Journal, November 30, 2002]

Avoiding Post-Operative Pain
                                                                                                           

From 10 to 50 percent of patients undergoing common operations such as hernia repair and coronary artery bypass surgery experience both acute and chronic post-operative pain.

Studies show that nerve damage is a major component of post-operative pain. Doctors recommend the use of surgical techniques that avoid nerve damage as much as possible plus early therapy to prevent the development of pain syndromes.
[SOURCE: Henrik Kehlet, et al, “Persistent Postsurgical Pain: Risk factors and Prevention,” The Lancet, May 13, 2006]

Carotid Angioplasty: Who Is It For?                                                                                                 


Angioplasty and placement of stents in the carotid artery of the neck is a promising investigative treatment for the prevention of stroke. Medical specialists usually recommend the procedure for persons with medical conditions making surgery risky, those who have previously had radical neck surgery or radiation treatment and those whose arteries have narrowed again following carotid surgery. The procedure is not advised for persons who have had a recent stroke or a blood clot in the affected artery.
[SOURCE: Wendi Pope, "Angioplasty & Stenting in the Carotid: Carotid Angioplasty and Stenting May Soon Become the Treatment of Choice for Certain Patients with Severe Carotid Artery Disease. Get Ready. You May Soon Be Caring for These Patients," RN, June, 2002]

Distress No Reason for Back Surgery

Chronic back pain can lead to a great deal of distress, but distressed persons may be among the least likely to benefit from back surgery, according to research presented at the 2005 meeting of the American Academy of Orthopaedic Surgeons. Jeffery C. Wang, M.D., a UCLA spine surgeon, reported that psychologically distressed patients often have poor surgical results even though they may otherwise appear to be good candidates. [SOURCE: Jeffery C. Wang, M.D., American Academy of Orthopaedic Surgeons; Salynn Boyles, WebMD Medical News, June 15, 2005]

 Double Transplant Sometimes an Option 
                                                                                               

Some type 1 diabetics with end-stage kidney failure are considered for a double transplant of both pancreas and kidney. The dual transplant eliminates the need for dialysis and for daily insulin injections. (The pancreas is the organ that supplies insulin to the body.) Success rates for the dual transplant are good-about 82 percent after one year with a patient survival rate of 92 percent. The one-year success rate for a kidney transplant is 94 percent with a five-year success rate of 75 percent. Deaths in kidney transplant patients are most often due to related health factors such as heart disease. 
[SOURCE: "Pancreatic and Islet Transplants," The Johns Hopkins White Paper: Diabetes, 2003]

 Gastric Bypass: Not for Everybody 
                                                                                               

Al Roker of the Today Show is one of increasing numbers of Americans opting for gastric bypass surgery-recommended only for individuals who are at least 100 pounds overweight. The procedure involves stapling the stomach so that food can enter only a small compartment, about the size of an egg. About 80,000 gastric bypasses are performed each year, but the fatality rate is 1 in 200. With time, the stomach pouch gets bigger again, so it's essential that the patient establish a regimen of healthy eating and exercise to maintain the weight loss.
[SOURCE: Michelle Tauber, "100 & Counting: A New Day Dawns for Today's Al Roker, Who Speaks Candidly about the Gastric Bypass surgery That Transformed His Life," People Weekly, November 18, 2002]

Hernia Surgery Safe Even for Elderly
                                                                                   

Even elderly patients with other medical conditions such as heart disease have undergone hernia surgery safely. In one study of 175 patients older than 66 years, there were no deaths and few complications, even though half of the patients had severe systemic disease and 22 percent had undergone coronary bypass graft surgery.
[SOURCE: Andrew Kingsworth and Karl LeBlanc, “Hernias: Inguinal and Incisional,” The Lancet, November 8, 2003]

Keep Working on Knees 
                                                                                                           

A two-year study comparing arthroscopic knee surgery to treat osteoarthritis with sham surgery concluded that the actual procedure was no more effective than the placebo. That doesn't mean, however, that there's no treatment for osteoarthritic knee pain. A Dutch study of 100 patients with osteoarthritis of the knee found that those who exercised and stayed active had greater muscle strength and mobility than those with sedentary lifestyles. Suggested activities include swimming, walking and bike riding. Other strategies such as injections of hyaluronic acid that increase joint elasticity, nutritional supplements aimed at repairing cartilage cells and physical therapy can all help maintain flexibility and reduce pain. 
[SOURCE: "Joint Council," Men's Health, November, 2002]

Knee Surgery for Your Child?
                                                                                               

Your 14-year-old daughter suffered a knee injury on the soccer field, and your doctor is talking about the possibility of surgery? There’s good reason to be taken aback, but it’s possible that surgery is the best solution.

Injury to ligaments along the side of the knee can often be treated with rest, bracing and physical therapy, but moderate to severe tearing of the anterior cruciate ligament (ACL) in the center of the knee usually does require surgery to prevent later knee problems. To protect growth plates, a modified surgical approach is needed. 

Once considered rare in adolescents, ACL injuries are becoming increasingly common with the increased popularity of soccer.
[SOURCE: Colin Moseley, M.D., “Partial Tears of the Anterior Cruciate Ligament in Children,” American Academy of Orthopaedic Surgeons Annual Meeting, March 16, 2006; “Adolescent Knee Injuries,”The Cleveland Clinic Information Center, updated March 22, 2007]

Longer Stent Found Effective                                                                                                 


In addition to using drug-coated stents in an effort to reduce the re-narrowing of arteries that can occur after balloon angioplasty, researchers are investigating the use of longer stents. According to research presented at the Transcatheter Cardiovascular Therapeutics conference [November, 2002], even a little additional length can be effective. "The longer the stent, the better the restenosis rates are," wrote Martin Leon, M.D. "We found that for every 10 millimeters of added stent, we gained an additional 13 percent [in reduction] of restenosis." 
[SOURCE: Kevin New and Larry Haimovitch, "Drug-Coated Stents Dominate, But Other Technologies Edge onto Stage," Cardiovascular Device Update, November, 2002]

New Hips for Younger Patients
                                                                       

Approximately 150,000 Americans opt for total hip replacement surgery each year to gain relief from the crippling pain of arthritis. In the past this option was considered most viable for elderly patients. As materials used for hip components evolve, doctors are increasingly willing to recommend the surgery to younger patients. Currently only 5 to 10 percent of hip replacement patients are under age 50. That figure may rise as new surgical materials and techniques make it possible for patients to keep the replacement hip for 20 years or more. Recent innovations include: cementless components that are pitted to allow bone to grow into the surface of the prosthesis; and a replaceable liner on the socket component of the prosthesis that allows a surgeon to go in and replace only the worn liner after a number of years.
[SOURCE: "Arthritis-Hip Replacement," Harvard Health Letter, February, 2002; "Hip Replacement Surgery Viable Option for Younger Patients," Medical Devices and Surgical Technology Week, March 17, 2002]

Surgery, Angioplasty or Medication? 
                                                                                   

For individuals with symptoms indicating they are at risk of a stroke because of severe blockages in the carotid artery of the neck, surgery or angioplasty is the preferred treatment. In one study of patients with 70 percent or greater blockages of the carotid artery, the risk of stroke was nine percent for those having surgery to remove the plaque compared to 22 percent for those being treated with medication. In another study, the risk associated with surgery was 12.3 percent versus 21.9 percent for medical treatment. A study of 504 patients randomly assigned to either surgery or angioplasty, found a combined mortality and stroke rate of 10 percent for each procedure. 
[SOURCE: Ian Lane and John Byrne, "Carotid Artery Surgery for People with Existing Coronary Artery Disease," Heart, January, 2002]

Talking about Organ Donation                                                                                                 


The field of organ transplantation has changed rapidly as a result of improved surgical techniques and more effective immunosuppressive drugs. The biggest drawback is a lack of donor organs. There are currently at least 78,000 Americans seeking organ transplants. Medical professionals are frequently faced with an accident victim who has signed a donor card, but the family is reluctant to give the necessary consent. Discussing the issues and making a decision in the absence of a traumatic event simplifies the emotional process for a family if a tragedy does occur. And although the thought of having organs taken from a deceased loved one may be difficult, many families find that gift of life to others a source of comfort in their grief. 
[SOURCE: "Number of Patients Awaiting Kidney Transplants Exceeds 50,000 for the First Time," Health Care Strategic Management, November, 2001]

Think Twice Before Choosing the Knife
                                                                                   

Some surgical procedures are necessary; others are elective, and patients should think twice and balance benefits against risks before making a final decision.

Spinal fusion is the most controversial type of back surgery. Of the 125,000 Americans who elect to have spinal fusion each year, at least 40 percent still feel back pain a year later.

Arthroscopic knee surgery has a role for treating sports injuries, but a VA study found that it offered no benefit for treating arthritic pain. Nevertheless, about 660,000 procedures are performed each year.

Most cases of shoulder tendinitis resolve on their own, but 140,000 Americans choose to have shoulder acromioplasty, despite the costs and risks of surgery.

About 650,000 women have uterine hysterectomies; many of these are believed to be unnecessary.
Gastric bypass surgery can be an effective treatment for obesity...but it’s costly and has potentially serious complications.
[SOURCE: American Academy of Orthopaedic Surgeons; American Society for Bariatric Surgery; Agency for Healthcare Research and Quality; “Under the Knife,” Forbes, October 27, 2003]