Surgical Rule Number One: If It’s Not Broke, Don’t Fix It

Surgical Rule Number One: If It’s Not Broke, Don’t Fix It By W. Gifford-Jones MD and Diana Gifford The most important lesson is often taught in the first class. This was the case at Harvard Medical School where a professor of surgery gave sound advice to students aspiring to hold the scalpel. He told them, “If it’s not broke, don’t fix it.” Another professor echoed this advice when he said, “There is no such thing as minor surgery.” How tragic when this simple message is ignored and the result is death. It should not happen. But it did recently in Canada, twice. Two children died following tonsil and adenoid surgery, shocking the nation with a wake-up call to alert that common procedures are not risk-free. What went wrong is being investigated. But it’s nightmare occurrence for the doctors and families alike. And we must all learn anew. Surgery is never minor, and if it is not needed, don’t go for it. Tonsillectomy is considered major surgery by the Otolaryngological Society. But one can bet most families would not perceive it as such. Rather, it’s seen as a quick, easy procedure to remove troublesome tonsils and or adenoids. Tonsils and adenoids are part of the immune system. Repeated infections or difficulty breathing lead to the decision for a surgery deemed safe. The main risk is bleeding up to 10 days after the operation. Needless surgery caused the demise of comedian Joan Rivers. She joked about going under the knife to tuck this and that. But it would be one too many. She died from cardiac arrest during a cosmetic procedure. The youngest victims are newborn babies having undergone circumcision and dying due to hemorrhage. Yet, day after day, this procedure continues to be done. Why? Some people believe it should be performed for religious reasons. Others site medical reasons, that it decreases cancer of the penis, a very rare disease, or decreases urinary infections in the first year of life. But does this mean all breasts should be removed at birth for fear of cancer or the nose to avoid infections? Some critics say circumcision violates the United Nations Declaration of Human Rights. After all, prior to newborn circumcision, no doctor or parents gain the consent of the child. Medical journals are full of surgical complications. They occur when too much skin is removed, when botched procedures make it hard to pass urine, or when mistakes lead to amputation of part of the penis. The foreskin is loaded with blood vessels and nerves that have a sexual function, not a surgical imperative. Ultrasound is often used during a medical workup to help diagnose a problem. On occasion an ultrasound will find large stones in the gallbladder that have been present for years without causing trouble. On the other hand, small stones can enter the cystic duct that carries bile to the intestines. This results in severe abdominal pain and requires emergency surgery. The best treatment for large silent stones is to leave them alone. If they start to cause pain, surgery would be needed. But the best treatment, in the absence of trouble, is to leave them for the crematorium. Why? Because during removal of the gallbladder there’s always a chance of injuring this small narrow duct. It happened to Athony Eden, one of England’s Prime Ministers, and is extremely difficult to repair, four subsequent surgeries in his case. Everyone knows heart surgery can be a life and death procedure. Don’t be fooled into thinking that common surgery is free of risk. Indifference becomes tragedy when something terrible happens. Sign-up at www.docgiff.com to receive our weekly e-newsletter. For comments, contact-us@docgiff.com. Follow us Instagram @docgiff and @diana_gifford_jones