AVOID OR PREVENT SURGERIES --Why? -Which surgeries ?-How?

AVOID & PREVENT SURGERIES

with PYANMED (mainly laser therapy ) for avoiding & preventing various surgeries e.g.:

? Heart bypass (CABG), angioplasty, valve surgery etc

? Spine surgeries degenerative diseases:

? Joints replacements (knee, hip etc)

? Amputation for gangrene, diabetic foot

? Piles, fissure, fistula, .D.V.T., D.N.S 

? Prostate-(B.P.H), Glaucoma, etc

ESSENTIAL SURGERIES:

Few surgeries can be life saving or great option for patients like removing foreign body from trachea, or creating anus for a baby born with no anus, uniting cleft palate, and acute intestinal obstruction.

There are few diseases wherein only surgery can relieve the patients as per present knowledge of Medicine. e.g hernia, hydrocoele.

The mankind is really indebted to surgeons for these types of essential surgeries. However one can not overlook the fact that essential surgeries are really quite a few in number.

WHY SURGERIES SHOULD BE AVOIDED?

Fact One: - Many surgeries are scientifically unproven: It is very difficult to believe, while it is absolutely true fact that many surgeries are not proven scientifically

If any new drug is to be made available it has to undergo approval from drug authority likes FDA, after submitting double blind trials. Unfortunately many surgeries are introduced without such double blind trial.

Surprisingly , a surgeon doing a particular surgery for decades may not know that, the surgery he is performing is proven (scientifically) or not.

Fact two: - Only few surgeries offer complete treatment:

Patients must understand well that, sometimes the surgery is just a quick but time being solution or some good help in the crisis and it is not at all a complete treatment aimed for long lasting cure. e.g.

1. Gall stone removal or renal stone removal:

The surgery is conducted here to take out the stone to relieve patient quickly. But surgery per se does not cure the in-depth problem at all. Unless something is done to correct basic pathology , for the basic tendency to form such stones the problem will always reoccur.

2. Spine Surgeries for degenerative diseases or P.I.D. ( prolapsed disc)

3. Heart Surgeries: like C.A.B.G(bypass) , Angioplasty:

When thousands of miles of blood vessels are partially blocked by plaque formation, FEW CENTIMETERS PATCHWORK (done under angioplasty or C.A.B.G-bypass .) is not going to help the patient in real sense --but surely will give some breathing time to correct underlying pathology

. If the plaque formation (blocks)is present in coronary artery, then it may also be present in several other arteries e.g. arteries of brain or kidneys or other arteries.

Therefore angioplasty or (C.A.B.G).bypass heart surgery is not an ideal in depth solution, as it attempts to correct only few centimeters when pathology is really very extensive in thousands of miles of blood vessels.

Fact Three: - Few surgeries offer difficult solution than the problem e.g Amputation

Surgeries like amputation for PAD or gangrene are apparently more terrifying than the disease itself . With PYANMED therapy most of the amputations are not really required and limbs can be saved.

Some surgeries like spine surgery for PID or degenerative spine diseases may cause dreaded complications like paralysis.

Fact Four: -

Some surgeries may be performed under wrong assumptions by a surgeon who has an attitude of " I KNOW ALL" e.g. transplantation of Pancreas or liver, T.K.R., T.H.R, Prostate removal, D.N.S, Tonsillectomy, Cesarean section, Appendectomy etc. If surgeons update themselves by research papers , many such surgeries can be avoided

With my PYANMED ( mainly laser therapy ) treatment , many surgeries are not really needed

e.g. D.N.S, tonsils, appendix, varicose veins, slip disc, prostate, mastoids, hysterectomy (removal of uterus), piles, fissure, hip replacement for A.V.N, T.K.R for O.A, T.H.R for O.A, lung transplant for fibrosis, liver transplant for cirrhosis etc.

Few other ways to avoid surgery at inception :

The surgeon must give in writing to the patient a “surgery advice form” before patient gives consent. In this form the surgeon must fill in following information:

1. Which surgery is advised, for what and why?

2. What exactly will be done in this surgery?

3. Under what anesthesia?

4. What surgeon expects as desired outcome from the proposed surgery? What is the probability of having desired results?

5. Is there any other option available for the patient, than surgery?

6. What could be untoward effects of the surgery?

7. What worst can happen, rarely in such surgery?

8. Is the advised surgery scientifically proven?

9. What are direct and indirect expenses?

10. Chances of re occurrence after surgery?

11. What if patient does not undergo surgery?

When this information is available in writing, then only the patient will be able to take proper studied decision and ideally this is real consent (informed consent).

References:

1. Li G, Warner M, Lange BH, Lin H, Sun LS. Epidemiology of anesthesia-related mortality in the United States, 1999-2005. Anesthesiology 2009;110:759-65. 

2. Gottschalk A, Van Aken H, Zenz M, Standl T. Is anesthesia dangerous? Dtsch Arztebl Int2011;108:469-74.

3. Kable AK, Gibberd RW, Spigelman AD. Adverse events in surgical patients in Australia.Int J Qual Health Care 2002;14:269-76. 

4. Zegers M, de Bruijne M, de Keizer B, Merten H, Groenewegen P, van der Wal G, et al. The incidence, root-causes, and outcomes of adverse events in surgical units: implication for potential prevention strategies. Patient Saf Surg 2011;5:13. 

5. Calland JF, Adams RB, Benjamin DK Jr, O’Connor MJ, Chandrasekhara V, Guerlain S, et al. Thirty-day postoperative death rate at an academic medical center. Ann Surg2002;235:690-6; discussion 6-8. 

6. McCulloch P, Altman DG, Campbell WB, Flum DR, Glasziou P, Marshall JC, et al. No surgical innovation without evaluation: the IDEAL recommendations. Lancet 2009;374:1105-12. 

7. Tenery R, Rakatansky H, Riddick FAJ, Goldrich MS, Morse LJ, O’Bannon JM 3rd, et al. Surgical “placebo” controls. Ann Surg 2002;235:303-7. [PMC free article] [PubMed]

 

8. Thomas KB. General practice consultations: is there any point in being positive? BMJ1987;294:1200-2.

9. . Wenner DM, Brody BA, Jarman AF, Kolman JM, Wray NP, Ashton CM. Do surgical trials meet the scientific standards for clinical trials? J Am Coll Surg 2012;215:722-30.

10. Gelijns AC, Ascheim DD, Parides MK, Kent KC, Moskowitz AJ. Randomized trials in surgery. Surgery 2009;145:581-7. 

11. Howes N, Chagla L, Thorpe M, McCulloch P. Surgical practice is evidence based. Br J Surg 1997;84:1220-3. 

12. Macklin R. The ethical problems with sham surgery in clinical research. N Engl J Med1999;341:992-6. 

13 Miller FG. Sham surgery: an ethical analysis. Am J Bioeth 2003;3:41-8. 

14. London AJ, Kadane JB. Placebos that harm: sham surgery controls in clinical trials. Stat Methods Med Res 2002;11:413-27. 

15  Gillespie MB, Wylie PE, Lee-Chiong T, Rapoport DM. Effect of palatal implants on continuous positive airway pressure and compliance. Otolaryngol Head Neck Surg2011;144:230-6. 

16. Steward DL, Huntley TC, Woodson BT, Surdulescu V. Palate implants for obstructive sleep apnea: Multi-institution, randomized, placebo-controlled study. Otolaryngol Head Neck Surg 2008;139:506-10. 

17. Davys HJ, Turner DE, Helliwell PS, Conaghan PG, Emery P, Woodburn J. Debridement of plantar callosities in rheumatoid arthritis: a randomized controlled trial. Rheumatology (Oxford, England) 2005;44:207-10. 

18. Deviere J, Costamagna G, Neuhaus H, Voderholzer W, Louis H, Tringali A, et al. Nonresorbable copolymer implantation for gastroesophageal reflux disease: a randomized sham-controlled multicenter trial. Gastroenterology 2005;128:532-40. 

19. Genco A, Cipriano M, Bacci V, Cuzzolaro M, Materia A, Raparelli L, et al. BioEnterics[reg] Intragastric Balloon (BIB[reg]): a short-term, double-blind, randomised, controlled, crossover study on weight reduction in morbidly obese patients. Int J Obes Relat Metab Disord 2006;30:129-33. 

20 . Friedman M, Schalch P, Lin HC, Kakodkar KA, Joseph NJ, Mazloom N. Palatal implants for the treatment of snoring and obstructive sleep apnea/hypopnea syndrome.Otolaryngol Head Neck Surg 2008;138:209-16. 

 

21. Van Schie CH, Whalley A, Vileikyte L, Wignall T, Hollis S, Boulton AJ. Efficacy of injected liquid silicone in the diabetic foot to reduce risk factors for ulceration: a randomized double-blind placebo-controlled trial. Diabetes Care 2000;23:634-8. 

22. Thompson C, Chand B, Chen Y, Demarco D, Miller L, Schweitzer M, et al. Endoscopic suturing for transoral outlet reduction increases weight loss after Roux-en-Y gastric bypass surgery. Gastroenterology 2013;145:129-37.

 

23 . Hartigan P. Sclerotherapy for male alcoholic cirrhotic patients who have bled from esophageal varices: results of a randomized, multicenter clinical trial. Hepatology 1994;20:618-25. 

24. . Salem M, Rotevatn S, Stavnes S, Brekke M, Vollset SE, Nordrehaug JE. Usefulness and safety of percutaneous myocardial laser revascularization for refractory angina pectoris. Am J Cardiol 2004;93:1086-91. 

25 . Geenen JE, Hogan WJ, Dodds WJ, Toouli J, Venu RP. The efficacy of endoscopic sphincterotomy after cholecystectomy in patients with sphincter-of-Oddi dysfunction. N Engl J Med 1989;320:82-7. 

26.. Rothstein R, Filipi C, Caca K, Pruitt R, Mergener K, Torquati A, et al. Endoscopic full-thickness plication for the treatment of gastroesophageal reflux disease: a randomized, sham-controlled trial. Gastroenterology. 2006;131:704-12. 

27 . Shaheen NJ, Sharma P, Overholt BF, Wolfsen HC, Sampliner RE, Wang KK, et al. Radiofrequency ablation in Barrett’s esophagus with dysplasia. N Engl J Med2009;360:2277-88. 

28. Sutton CJ, Ewen SP, Whitelaw N, Haines P. Prospective, randomized, double-blind, controlled trial of laser laparoscopy in the treatment of pelvic pain associated with minimal, mild, and moderate endometriosis. Fertil Steril 1994;62:696-700. 

 

29. . Laine L. Multipolar electrocoagulation in the treatment of active upper gastrointestinal tract hemorrhage. A prospective controlled trial. N Engl J Med 1987;316:1613-7. 

30. . Swank DJ, Swank-Bordewijk SCG, Hop WCJ, van Erp WFM, Janssen IMC, Bonjer HJ, et al. Laparoscopic adhesiolysis in patients with chronic abdominal pain: a blinded randomised controlled multi-centre trial. Lancet 2003;361:1247-51. 

31. Bradley JD, Heilman DK, Katz BP, Gsell P, Wallick JE, Brandt KD. Tidal irrigation as treatment for knee osteoarthritis: a sham-controlled, randomized, double-blinded evaluation.Arthritis Rheum 2002;46:100-8. 

32. Pauza KJ, Howell S, Dreyfuss P, Peloza JH, Dawson K, Bogduk N. A randomized, placebo-controlled trial of intradiscal electrothermal therapy for the treatment of discogenic low back pain. Spine J 2004;4:27-35. 

33. Stuck BA, Sauter A, Hormann K, Verse T, Maurer JT. Radiofrequency surgery of the soft palate in the treatment of snoring. A placebo-controlled trial. Sleep 2005;28:847-50.

34. Montgomery M, Hakanson B, Ljungqvist O, Ahlman B, Thorell A. Twelve months’ follow-up after treatment with the EndoCinch endoscopic technique for gastro-oesophageal reflux disease: a randomized, placebo-controlled study. Scand J Gastroenterol 1382;41:1382-9. 

35. Hogan RB, Johnston JH, Long BW, Sones JQ, Ardell Hinton L, Bunge J, et al. A double-blind, randomized, sham-controlled trial of the gastric bubble for obesity. Gastrointest Endosc1989;35:381-5. 

36. . Jarrell J, Mohindra R, Ross S, Taenzer P, Brant R. Laparoscopy and reported pain among patients with endometriosis. J Obstet Gynaecol Can 2005;27:477-85. 

37 Kallmes DF, Comstock BA, Heagerty PJ, Turner JA, Wilson DJ, Diamond TH, et al. A randomized trial of vertebroplasty for osteoporotic spinal fractures. N Engl J Med2009;361:569-79.

38. . Buchbinder R, Osborne RH, Ebeling PR, Wark JD, Mitchell P, Wriedt C, et al. A randomized trial of vertebroplasty for painful osteoporotic vertebral fractures. N Engl J Med2009;361:557-68. 

39. . Lee PE, Kung RC, Drutz HP. Periurethral autologous fat injection as treatment for female stress urinary incontinence: a randomized double-blind controlled trial. J Urol 2001;165:153-8.

 

40. Malley K, Petersen NJ, Menke TJ, Brody BA, Kuykendall DH, et al. A controlled trial of arthroscopic surgery for osteoarthritis of the knee. N Engl J Med2002;347:81-8. 

41. . . Cobb LA, Thomas GI, Dillard DH, Merendino KA, Bruce RA. An evaluation of internal-mammary-artery ligation by a double-blind technic. N Engl J Med 1959;260:1115-8.

42. . Felson DT, Buckwalter J. Débridement and lavage for osteoarthritis of the knee. N Engl J Med 2002;347:132-3. 

43. . Weinstein JN. Balancing science and informed choice in decisions about vertebroplasty. N Engl J Med 2009;361:619-21. 

---

Articles from The BMJ are provided here courtesy of BMJ Publishing Group