Surgery is a trauma, regardless of the surgeon's skills.

5 Operations You Don't Want to Get -- and

What to Do instead?
Story Highlights

At least 12,000 Americans die each year from unnecessary surgery

U.S. women undergo twice as many hysterectomies per capita as British women
Surgeons perform 1.2 million angioplasties annually in the U.S.
In many cases, nonsurgical alternatives may be worth a look

Maybe I'm the wrong ex-patient to be telling you this: Experimental surgery era sed Stage III
colon cancer from my shell-shocked body six years ago. But even I've got to admit that all is not
well in America's operating rooms: At least 12,000 Americans die each year from unnecessary
surgery, according to a Journal of the American Medical Association report. An d tens of
thousands more suffer complications.
The fact is, no matter how talented the surgeon, the body doesn't much care about the doc's
credentials. Surgery is a trauma, and the body responds as such -- with major blo od loss and
swelling, and all manner of nerve and pain signals that can stick around sometim es for months.
Those are but a few reasons to try to minimize elective surgery. And I found even m ore after
talking with more than 25 experts involved in various aspects of surgery and sur gical care, and
after reviewing a half-dozen governmental and medical think tank reports on su rgery in the
United States. Here's what you need to know about five surgeries that are overus ed and
alternative solutions that may be worth a look.

Hysterectomy
There's long been a concern, at least among many women, about the high rates of hy sterectomy
(a procedure to remove the uterus) in the United States. American women undergo twice as
many hysterectomies per capita as British women and four times as many as Swedis h women.

The surgery is commonly used to treat persistent vaginal bleeding or to remove b enign fibroids
and painful endometriosis tissue. If both the uterus and ovaries are removed, i t takes away
sources of estrogen and testosterone. Without these hormones, the risk of hear t disease and
osteoporosis rises markedly. There are also potential side effects: pelvic pr oblems, lower sexual
desire and reduced pleasure. Hysterectomies got more negative press after a la ndmark 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? "Our professio n is entrenched
in terms of doing hysterectomies," says Ernst Bartsich, M.D., a gynecological surgeon at Weill-
Cornell Medical Center in New York. "I'm not proud of that. It may be an acceptabl e procedure,
but it isn't necessary in so many cases." In fact, he adds, of the 617,000 hystere ctomies
performed annually, "from 76 to 85 percent" may be unnecessary.
Although hysterectomy should be considered for uterine cancer, some 90 percen t of procedures
in the United States today are performed for reasons other than treating cancer , according to
William H. Parker, M.D., clinical professor of gynecology at UCLA and author of the '05 study.
The bottom line, he says: If a hysterectomy is recommended, get a second opinion and consider
the alternatives.

What to do instead
Go knife-free. Endometrial ablation, a nonsurgical procedure that targets th e uterine lining, is
another fix for persistent vaginal bleeding. Health.com: Your guide to fibroid fixes
Focus on fibroids. Fibroids are a problem for 20 to 25 percent of women, but there are several
specific routes to relief that aren't nearly as drastic as hysterectomy. For in stance, myomectomy,
which removes just the fibroids and not the uterus, is becoming increasingly po pular. And there
are other less-invasive treatments out there, too.
In France in the early 1990s, a doctor who was prepping women for fibroid surgery -- by
blocking, or embolizing, the arteries that supplied blood to the fibroids in th e uterus -- noticed a
number of the benign tumors either soon shrank or disappeared, and, voila, Jacq ues Ravina,
M.D,. had discovered uterine
fibroid embolization.
Since then, interventional
radiologists in the United States
have expanded their use of
UFE (typically a one- to three-
hour procedure), using
injectable pellets that shrink
and "starve" fibroids into
submission. Based on research
from David Siegel, M.D., chief
of vascular and interventional
radiology at Long Island Jewish
Medical Center, New Hyde
Park, New York, 15,000 to
18,000 UFEs are performed
here each year, and up to 80
percent of women with fibroids
are candidates for it.

Another new fibroid treatment is high-intensity focused ultrasound, or HIFU. This even less
invasive, more forgiving new procedure treats and shrinks fibroids. It's what 's called a no-scalpel
surgery that combines MRI (an imaging machine) mapping followed by powerful so und-wave
"shaving" of tumor tissue.

Episiotomy
It can sound so simple and efficient when an OB-GYN lays out all the reasons why sh e performs
episiotomy before delivery. After all, it's logical that cutting or extending the vaginal opening
along the perineum (between the vagina and anus) would reduce the risk of pelvic -tissue tears
and ease childbirth. But studies show that severing muscles in and around the lo wer 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 --
and the numbers have dropped. Many
doctors now reserve episiotomy for cases
when the baby is in distress. But the rates
(about 25 percent in the United States) are
still much too high, experts say, and some
worry that it's because women aren't
aware that they can decline the surgery.
"We asked women who'd delivered
vaginally with episiotomy in 2005 whether
they had a choice," says Eugene Declercq,
Ph.D., main author of the leading national
survey of childbirth in America, "Listening
to Mothers II," and professor of maternal and child health at the Boston Univers ity School of
Public Health. "We found that only 18 percent said they had a choice, while 73 per cent said they
didn't." In other words, about three of four women in childbirth were not asked a bout the surgery
they would soon face in an urgent situation. "Women often were told, 'I can get th e baby out
quicker,'" Declercq says, as opposed to doctors actually asking them, 'Would y ou like an
episiotomy?'"

What to do instead
Communicate. The time to prevent an unnecessary episiotomy is well before labo r, experts
agree. When choosing an OB-GYN practice, ask for its rate of episiotomy. And whe n you get
pregnant, have your preference to avoid the surgery written on your chart.
Get ready with Kegels. Working with a nurse or midwife may reduce the chance of su ch surgery,
experts say; she can teach Kegel exercises for stronger vaginal muscles, or per form perineal
and pelvic-floor massage before and during labor. Health.com: Me and my Kegels

Angioplasty
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 Roto-Rooter-type
approach is less invasive and has a shorter recovery
period than bypass, which is open-heart surgery.
The problem: 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.
The bottom line: Angioplasty did not appear to prevent
heart attacks or save lives among nonemergency
heart subjects in the study.

What to do instead
Take the right meds. If the study is right, medications
may be as strong as steel. "If you have chest pain and are stable, you can take medi cines that
do the job of angioplasty," says William Boden, M.D., of the University of Buffa lo School of
Medicine, Buffalo, New York, and an author of the study. Medicines used in the st udy included
aspirin, and blood pressure and cholesterol drugs -- and they were taken along w ith exercise and
diet changes. Health.com: Keep your heart healthy
"If those don't work, then you can have angioplasty," Boden says. "Now we can une quivocally
say that."
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. Th e onus is also on the
patient to treat a doc's lifestyle recommendations -- diet and exercise guidel ines -- just as
seriously as if they were prescription medicines.

Heartburn surgery
A whopping 60 million Americans experience
heartburn at least once a month; 16 million deal
with it daily. So it's no wonder that after suffering
nasty symptoms (intense stomach-acid backup or
near-instant burning in the throat and chest after
just a few bites), patients badly want to believe
surgery can provide a quick fix. And, for some, it
does.
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, M.D., 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.
Remes-Troche believes it's best for very serious
cases of long-standing gastroesophageal reflux
disease, or GERD, or for those at risk of Barrett's
esophagus, a disease of the upper gastrointestinal
tract that follows years of heartburn affliction and
can be a precursor to esophageal cancer.

What to do instead
Make lifestyle changes. A combination of diet,
exercise, and acid-reducing medication may help
sufferers beat the burn without going under the
knife. But it's a treatment that requires
perseverance.
"It took me four years of appointments, diets, drugs, sleeping on slant beds -- a nd even yoga --
to keep my heartburn manageable," says Debbie Bunten, 44, a Silicon Valley busi ness-
development manager for a software firm, who was eager to avoid surgery. "But I d id it, and am
glad I did." Health.com: Feel better, naturally
Pose for a picture. Another technological development can make a heartburn dia gnosis 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 har mlessly out of
your system four to six hours later. The device can be used instead of standard en doscopy to
screen chronic-heartburn sufferers for various esophageal complaints, incl uding GERD, which
can develop into the potentially precancerous Barrett's esophagus. Unlike an endoscopy, in
which you're sedated and a lighted tube is snaked down your throat, a capsule cam era leaves
you wide awake and is finished within 20 minutes, says Pillcam guru David Fleisc her, M.D., a
staff physician in gastroenterology and hepatology, and professor of medicin e at Mayo Clinic
College of Medicine. If anesthesia makes you sick, the capsule camera may be for you.

Lower-back surgery
Since the 1980s, operations for lower-back pain and sciatica have increased ro ughly 50 percent,
from approximately 200,000 to more than
300,000 surgeries annually in the United
States. That rise is largely due to minimally
invasive advances that include endoscopic
keyhole tools used in tandem with
magnified video output.
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, M.D., director of the brand new
Centeno-Schultz Pain Clinic near Denver,
Colorado. And that adds up to tens of
thousands of frustrated patients who find
the promise of surgery was overwrought or
short-lived.

What to do instead
Try painkillers and exercise. Despite the relentless nature of lower-back pai n, the most common
cause is a relatively minor problem -- muscle strain -- not disc irritation, dis c rupture, or even a
bone problem, experts say. Despite its severity, this type of spine pain most of ten subsides
within a month or two. That's why surgery, or any other invasive test or treatmen t beyond light
exercise or painkillers, is rarely justified within the first month of a compla int. Even pain caused
by a bulging or herniated disc "resolves on its own within a year in some 60 percen t of cases,"
orthopedists claim.
"Seventy to eighty percent of the time we can get to a concrete diagnosis, find a w ay to manage
pain, and get patients off the drugs without surgery," Centeno says. "Or, more a ppropriately,
never start the drugs."

"We used to prescribe 30 days bed rest for patients with herniated discs, but tha t was 15 to 20
years ago," says Venu Akuthota, M.D., medical director of the Spine Center at Un iversity of
Colorado Hospital and associate professor of medicine at the University of Col orado School of
Medicine. "Actually, movement is very helpful for treating back conditions. N owadays, we
prescribe moderate, low-impact exercise, like walking, or working out on an el liptical trainer or
treadmill." Health.com: The best new pain cures
Learn about stem cells. I've seen the future of back surgery firsthand. And it lo oked to me, from
behind my surgical mask, as if a woman's bare behind was doing much of the work. Up close,
huddled inside the Centeno-Schultz Pain Center, I joined a team of M.Ds., a Ph.D ., and two
nurses to witness orthopedic history in vivo: an adult stem cell transplant to h elp bones and joints
grow anew.
In the midst of the huddle, Centeno, the back- and neck-pain specialist, is plun ging a needle that
looks big enough to use on a horse deep into the hip bone of a 54-year-old weekend a thlete and
skier who's been forced to the sidelines by injury and long-term lower-back pai n. The patient is
tired of pain pills but wary of major surgery. Instead she's undergoing one of th e first ASC
orthopedic transplants in the nation.
The harvested stem cells will be used to grow millions of new ones that will be imp lanted in her
back to spur and regenerate more youthful, healthy joint tissue -- if all goes as planned in this
part of an ongoing study approved by a medical research institutional review bo ard, that is. So
far, at least, it has. Early MRI pictures of related procedures have shown impre ssive growth of
regenerative tissue. And there's even better news: By using the patient's own s tem cells, the
surgical team avoids the ethical debate over using embryonic tissue for resear ch purposes.
Compiled By: Dr.M.Kumaravel

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