Factors that Affect Surgical Decisions for the Individual

Having surgery. How scary: the first thing the surgeon explains are risks. Risk of death, risk of complications.
How does one decide if to go ahead with it?
Some people don’t even have a choice. They must undergo surgery. They suffer from an acute catastrophe, such as appendicitis, a dead gallbladder, a perforated ulcer, a bursted aneurysm… To them, surgery may be seen as a welcome relief from pain or that sensation of near death that accompanies the critically ill when they are still conscious.

But for the rest of us, the vast majority, the news comes in the doctor’s office, during a regular, scheduled visit.

Some of us don’t have pain, just a lump. And we’re told it’s cancer. In addition to the news that we need surgery, we’re told a million other things that will affect our health at least for the next year. Though I had patients who believed that homeopathic remedies were able to get rid of their cancers without an operation, I have not seen a single study performed on any of these herbs which consistently shows a cure. So my suggestion is that if there is a diagnosis of a cancer amenable to surgical resection, to take a family member with you, read up on that particular kind of cancer, take a list of questions, and bombard your surgeon with them. You want to know as much as possible. And if the answers don’t jive with you, get a second opinion. A week or two will not make a bit of a difference in your survival, and it will save you regrets later.

Some operations are done today with an endoscope, and tiny incisions are all that’s required. Pain is minimized, though complications and risks remain the same.

There are conditions that may require surgery some day, but can be put off for a while. A classic example is hernia. We used to say that there was an immediate risk just because the hernia was there, but now, in the absence of symptoms, such as pain or nausea, hernias may not need immediate repair.

Choices of anesthesia will vary with the general health of the individual.
Many patients are at high risk for general anesthesia. Diabetes, uncontrolled hypertension, lung disease, a bad heart, a history of a recent heart attack or a stroke are the most common deterrents to performing elective surgery without a thorough work up to address problems before they manifest themselves during an operation.

But even that is no guarantee that those problems will arise. Most surgeons obtain the so called ‘medical clearance’ for surgery by performing tests to assess how fit is a patient at high risk, and may decline to perform operations unless absolutely necessary.

Most bowel surgery requires a bowel prep, to clean the gut of bacteria. The intestine is not sterilized, just the load of bacteria is dramatically reduced. But a bowel prep is no fun. For those of us who listened to our doctors and did undergo a screening colonoscopy at the age of fifty, a bowel prep is an unpleasant memory of drinking bad tasting liquid, getting cramps, and filling the toilet, sometime in the middle of the night. It is an unfortunate but necessary evil to prevent disastrous infections during or right after surgery.

Lastly, the most important part of preparation for surgery is to have all your questions answered, a friendly environment, a supportive family and a positive attitude. There is light at the end of that tunnel.