Are Surgery and The Preoperative Tests Necessary?

The word surgery often brings with it a little fright and apprehension. As a surgeon, one of the most common questions I get asked is if surgery is really needed and is there no medical cure? I tell them this - “If there was one, I would have offered it to you”.

Surgery without risks? Not really

Doctors usually suggest surgery when it is the only way or when an early intervention can prevent further damage. Which brings us to the next most common question of the risks involved.

Every drug you take, every needle prick and every surgery has a percentage of risk involved. There is risk involved even when you cross a road but that doesn't mean you stop crossing roads, right? Similarly, despite the risks, some conditions just cannot be treated without a surgery. In my years of experience as a surgeon, I have seen cases where surgery was warranted before and patients who had stalled the procedure, ended up becoming inoperable.

So, it goes without saying that risk is a part of any surgery and can also be related to the drugs used or the patient’s pre-existing health condition including complications. All of which have to be explained to the patient prior to any procedure with a written consent taken from them.

Testing times

Another question I get asked often is regarding the tests prescribed before any surgery. Why are there so many? There is a battery of tests that surgeons do before the patient lands up in the Operating Room. And in the event of an abnormality, further testing may be required and other doctors may be consulted for fitness for surgery.

Here is a list of some common tests that a patient is asked to undergo before a surgery:

Comman Pre Operative Investigations

InvestigationsUse To The Patients/Hospital
Complete Blood PictureAnaemic, to reserve blood in the event of blood loss related to surgery for transformation.during surgery or in the post operative period, any active systemic infection
Random Blood SugarScreening for diabetes=Increased risk of infection post operatively
RenalTo make sure that the drugs given during surgery will not be toxic to the kidneys and that they will leave the system normally.
Chest RadiographIn the event of general Anaesthesia that may have to be considered, the lungs and heart condition determine the efficacy of Anaesthesia and the ability of the Patients to sustain the Anaesthesia
ECGAn Electronic Recording in a graphic format to make sure your heart is functionally normally, A screening tool for further cardiac evaluation if needed
Bleeding and Clotting TimeTo make sure that patients will not bleed to death on the bed and that the bleeding will eventually stop
HIVTransmitted Via all kind of Body Fluids, the Risk for Hepatitis B is higher than any HIV. Done to make sure extra protection and care is taken in positive patients and sharps used in such cases disposed off properly
Recovery and beyond

The time taken to recover from a surgery depends naturally, on the type of surgery itself, the organs involved and the setup in which the surgery is performed. Certain procedures that used to require 3-4 days of hospital stay are now being done in day care surgery with a hospital stay of less than 24 hours.

That has been made possible with the help of minimally invasive procedures like laparoscopy. It is a low risk procedure that requires only small incisions to be made to the body. This type of surgery uses an instrument called a  laparoscope which is a long, thin tube with a high-intensity light and a high resolution camera at the front. The infection rates, pain, recovery and back to mobility are all better in such surgeries. Not all cases though are eligible for laparoscopic surgeries. But that is a topic for another day.

Ultimately, if there is a surgical cure to a particular condition, a non-invasive or a medical approach will only delay the natural course of disease but not prevent the patient from going under the knife if the delay has not resulted in inoperability. Upon medical advice, the percentage of people who have opted for a surgery at an appropriate time has been growing and it has been directly proportional to the recovery rates.

For some people, there is a good structure and support at home for recovery and for others it's not so solid. Laparoscopic surgery may be an option for the latter group in view of the recovery time.

There are costs involved

Another concern for people is the cost of getting a surgery done. While there are situations where money or the lack of it is a real issue and one should find a centre where treatment is subsidised, if necessary. But in all other situations, it's really a cost vs benefits assessment. If your quality of life, physical, mental, social is affected by your medical condition and if surgery will resolve that, then the money factor is a small cost of the elevated quality of life post surgery and alleviation of the symptoms.

You have to assess for yourself on how much is the medical condition hampering you from living confidently and freely. If it is stopping you from what you want to and need to do in your daily routine; if it's like a sword hanging over your head to wake up to it every morning; if it is stopping you from engaging in activities freely; do factor in the limited lifestyle and what is possible if you undergo surgery. Weight it between the cost of surgery and the cost of quality of life.

Clarity pulls for action

The ideal thing to do for a patient to do is to have a very positive and strong approach if and when undergoing a surgery and trust their surgeon. Put all your fears and questions on the table to your surgeon. Get them clarified. Talk to people who have successfully undergone that surgery. Get all the information and then look at what is the best option for you with the symptoms you are dealing with and also as importantly the quality of life you desire.


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