5 operations you don't want to get -- and what to do instead p.2

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

       "If those don't work, then you can have angioplasty," Boden says. "Now we can unequivocally 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. The onus is also on the patient to treat a doc's lifestyle recommendations -- diet and exercise guidelines -- 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 -- and even yoga -- to keep my heartburn manageable," says Debbie Bunten, 44, a Silicon Valley business-development manager for a software firm, who was eager to avoid surgery. "But I did it, and am glad I did." Health.com: Feel better, naturally

       Pose for a picture. Another technological development can make a heartburn diagnosis 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 harmlessly out of your system four to six hours later. The device can be used instead of standard endoscopy to screen chronic-heartburn sufferers for various esophageal complaints, including 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 camera leaves you wide awake and is finished within 20 minutes, says Pillcam guru David Fleischer, M.D., a staff physician in gastroenterology and hepatology, and professor of medicine 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 roughly 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 pain, the most common cause is a relatively minor problem -- muscle strain -- not disc irritation, disc rupture, or even a bone problem, experts say. Despite its severity, this type of spine pain most often subsides within a month or two. That's why surgery, or any other invasive test or treatment beyond light exercise or painkillers, is rarely justified within the first month of a complaint. Even pain caused by a bulging or herniated disc "resolves on its own within a year in some 60 percent of cases," orthopedists claim.

       "Seventy to eighty percent of the time we can get to a concrete diagnosis, find a way to manage pain, and get patients off the drugs without surgery," Centeno says. "Or, more appropriately, never start the drugs."

       "We used to prescribe 30 days bed rest for patients with herniated discs, but that was 15 to 20 years ago," says Venu Akuthota, M.D., medical director of the Spine Center at University of Colorado Hospital and associate professor of medicine at the University of Colorado School of Medicine. "Actually, movement is very helpful for treating back conditions. Nowadays, we prescribe moderate, low-impact exercise, like walking, or working out on an elliptical 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 looked 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 help bones and joints grow anew.

       In the midst of the huddle, Centeno, the back- and neck-pain specialist, is plunging a needle that looks big enough to use on a horse deep into the hip bone of a 54-year-old weekend athlete and skier who's been forced to the sidelines by injury and long-term lower-back pain. The patient is tired of pain pills but wary of major surgery. Instead she's undergoing one of the first ASC orthopedic transplants in the nation.

       The harvested stem cells will be used to grow millions of new ones that will be implanted 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 board, that is. So far, at least, it has. Early MRI pictures of related procedures have shown impressive growth of regenerative tissue. And there's even better news: By using the patient's own stem cells, the surgical team avoids the ethical debate over using embryonic tissue for research purposes.

Article first published July 27, 2007 on CNN Health website. http://articles.cnn.com/2007-07-27/health/healthmag.surgery_1_hysterectomy-surgery-uterine-cancer?_s=PM:HEALTH