Summary

  • You have a right to get a second opinion and to choose not to have a treatment that you feel uncomfortable with.
  • It is your surgeon’s job to clearly explain all of your options.
  • Your surgeon will ask you to sign a form to say that you understand and agree to your surgery and the risks involved.
  • If you need some extra support when talking to your surgeon, you can ask someone like a friend or family member to help you.

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A handful of non-urgent elective surgical procedures have been found to have limited benefits, except in very specific circumstances.

If you’re being considered for one of the procedures listed below, it’s important to be fully informed of the associated risks and alternative treatment options available.

A printable guidance resource is available to help you have an open conversation with your healthcare provider about these procedures, and to support you in making a shared decision on the best care option for you.

The guidance contains:

  • key questions to raise with your healthcare provider
  • a brief summary of each of the identified procedures.

Download the Best Care consumer guidance or view the information below.

More information on the Best Care initiative and guidance for clinicians is available on the Safer Care Victoria website.

Learn more about making decisions about surgery

Key questions to ask your healthcare provider

  • What are the risks I need to be aware of for this surgery?
  • Further example questions:
    • Are there any risks with anaesthesia?
    • What are the side effects of this surgery?
    • How effective is this treatment in both the short and long term?
  • How will this treatment manage my health situation?
  • Are there other less invasive treatment options available?
  • What happens if I do not have this surgery?
  • Where can I find out more about this surgery and my other treatment options?

Download the Best Care consumer guidance  and add your own questions to take to your next appointment with your healthcare provider.

Identified procedures

General surgery procedures

  • Inguinal hernia repair for clinically unapparent groin hernia in adults

    An inguinal hernia occurs when the fatty or intestinal tissue pushes through a weakness in the abdominal wall near the groin area. It usually appears as a lump. The lump may be painful. It might also affect your daily activities.

    Inguinal hernia repair refers to a surgical procedure to repair the weakness in the abdominal wall. It can help to relieve symptoms such as pain or discomfort.

    An inguinal hernia repair is not recommended for someone who has minimal symptoms or only a small groin hernia with no symptoms or that is only found using an ultrasound test.

    For people who are in pain with a groin hernia, the benefits and risks of an inguinal hernia repair need to be considered alongside your overall health.

    Regular review by your surgeon is required to ensure your condition is managed appropriately.

  • Interval cholecystectomy following acute cholecystitis or gall stone pancreatitis

    Acute cholecystitis is a condition when the gall bladder becomes inflamed. Gallstone pancreatitis refers to a condition that inflames your pancreas and causes pain due to a gallstone blocking the pancreatic duct. You would need to seek hospital treatment for either of these conditions.

    When you are being treated in hospital for acute cholecystitis or gallstone pancreatitis, removing the gall bladder (cholecystectomy) is the best treatment option. This should occur between 48 and 72 hours of your admission. Sometimes a cholecystectomy cannot be performed within this timeframe. Reasons for delayed surgery include an existing medical or other health condition, the length of time you have had your symptoms or new findings by the medical team when they are doing tests. On these occasions you will be scheduled for an interval cholecystectomy after your discharge.

     
  • Double mastectomy for cancer in a single breast

    Treatment for breast cancer often involves surgery to remove part or all of the breast. When the whole breast is surgically removed, it is called a mastectomy.

    If you have a single breast cancer and no genetic risk (speak with your health professional to find out if you do), a double mastectomy (removing both breasts) will not generally be done.

    A double mastectomy will have little impact on improving your life expectancy, and there is a very low risk of developing cancer in the other breast if you have cancer in a single breast and no genetic risk.

    Speak to your health professional about what surgical options are available to you. Your cancer type and the severity will help to determine the most suitable treatment for you.

     

Orthopaedic and neurosurgical procedures

  • Diagnostic knee arthroscopy

    Osteoarthritis is the most common arthritis of the knee. It is a condition where the cartilage in the knee gradually breaks down and can cause pain, stiffness and swelling. A knee arthroscopy is a surgical procedure that can be used to examine and treat the knee joint. It should not be used to treat a patient with uncomplicated knee osteoarthritis.

    If you have uncomplicated knee osteoarthritis, your health professional might prescribe the following treatment: exercise, physiotherapy, education, weight loss and/or pain relief medication. If regular treatments are no longer working to control your pain or maintain your function, joint replacement surgery may be the next option.

    Sometimes a diagnostic knee arthroscopy in the case of knee osteoarthritis is appropriate. Speak with your health professional about your current situation to plan your treatment.

     
  • Spinal fusion surgery for chronic, axial back pain

    Spinal fusion is a surgical procedure that connects two or more spinal bones together by placing a bone graft between them.

    Chronic axial low back pain refers to back pain that lasts longer than three months. The pain is localised, meaning it is only located in the back and has not spread to the legs or affected the function of the legs.

    If you have chronic axial back pain, it is best managed through a variety of non-surgical treatment options. Options range from exercise and physiotherapy through to pain relief medication and psychological therapies. A spinal fusion for treating chronic axial back pain is appropriate only in certain circumstances.

    Speak with your health professional about what options are best for treating your chronic axial back pain.

     

Gynaecology procedures

  • Endometrial biopsy for routine fertility work-up

    An endometrial biopsy is a procedure where a sample of the endometrial lining of the uterus is taken for testing.

    If you are having a routine fertility work-up, your health professional would normally ask you questions about your medical history and perform a physical examination. This information would be combined with results from any tests your partner underwent.

    Further testing may be required along the way; however, an endometrial biopsy should not be part of the initial testing phase.

    Speak to your health professional about what is involved in a routine fertility work-up.

  • Dilation and curettage for heavy menstrual bleeding

    Dilatation and curettage (D&C) is one of the most common procedures performed in obstetrics and gynaecology. It is a procedure where the lining of the uterus is either sampled or emptied by a gynaecologist with an instrument called a curette.

    Heavy menstrual bleeding (HMB) is a term used to describe menstrual bleeding that is unusually heavy, lasts a long time or comes irregularly. It should be treated when it interferes with your quality of life or causes you anaemia.

    HMB should not be treated until the reason for it occurring is figured out and cancer has been excluded.

    The first thing you will try is medication to treat the HMB once the cause of it is known. If medication does not work or there are significant side effects from it, surgery may be appropriate. 

    A D&C should not be offered as a treatment option for HMB.

    Speak to your health professional about what options are available to you to treat your HMB.

  • Endometrial ablation for abnormal uterine bleeding in non-pregnant, premenopausal women

    Endometrial ablation is a surgical procedure performed under light sedation or a general anaesthetic that involves using heat to destroy the endometrium (the lining of the uterus).

    The aim of this procedure is to reduce menstrual bleeding.

    Abnormal uterine bleeding (AUB) is when there is excessive menstrual blood loss that interferes with quality of life. 

    To treat AUB, your health professional will first confirm the source of your bleeding. Once this has been worked out, and cancer excluded, your health professional will discuss treatment options with you.

    You will probably be treated with medication as a first step.

    In most cases, endometrial ablation should not be offered until medical treatments have been unsuccessful.

    Speak with your health professional to discuss what options are available to you to treat your AUB.

  • Hysterectomy for asymptomatic fibroids

    A hysterectomy is an abdominal, vaginal or laparoscopic (keyhole) surgery where the uterus and, in some cases, the ovaries and/or fallopian tubes are removed.

    Fibroids are tumours that develop in the uterus and are usually benign (hot harmful).

    Fibroids do not need to be treated if you do not experience any symptoms from them. They will often shrink and disappear over time without treatment, and particularly after menopause.

    A hysterectomy is not recommended to treat fibroids that do not cause any symptoms.

    Speak with your health professional if you notice any changes to symptoms relating to fibroids.

  • Hysterectomy for heavy menstrual bleeding in non-pregnant, premenopausal women

    A hysterectomy is an abdominal, vaginal or laparoscopic (keyhole) surgery where the uterus and, in some cases, the ovaries and/or fallopian tubes are removed.

    Heavy menstrual bleeding (HMB) is a term used to describe menstrual bleeding that is unusually heavy, lasts a long time or comes irregularly. It should be treated when it interferes with your quality of life or causes you anaemia (not enough red blood cells in your body).

    Your health professional will investigate what is causing your HMB. Once the cause for your HMB is worked out, medication may be offered to treat it.

    You should try medication and be offered other surgical options before considering a hysterectomy.

  • Abdominal (open) hysterectomy

    An abdominal (open) hysterectomy is major surgery where the uterus and, in some cases, the ovaries and/or fallopian tubes are removed.

    If your health professional says you need a hysterectomy (excluding during a life-threatening emergency), they should first ask you about how the symptoms are affecting your life, whether you wish to get pregnant in future, what other treatments you have tried, and what other options might be.

    If a hysterectomy is required, procedures that are ‘less invasive’ (procedures that enter through the vagina or keyhole surgery) should be considered.

Ear nose and throat procedures

  • Paediatric adenoidectomy as an isolated procedure

    An adenoidectomy is an operation to remove the adenoids. The adenoids are a patch of tissue that sit at the back of the nose cavity. They help to keep your body healthy by catching harmful bacteria and viruses that you breathe in.

    If your child is experiencing any ear, nose and throat symptoms, take them to a health professional.

    You will often be asked to keep an eye on your child and their symptoms for a period of time to help work out the best treatment. An adenoidectomy as a procedure by itself is only recommended in certain circumstances and would be advised by a specialist at the appropriate time.

     
  • Myringotomy for middle ear disease in children or adults

    The middle ear is a closed space that receives air via the eustachian tube. The eustachian tube is less developed in young children than in adults, which sometimes means the middle air doesn’t get enough air. Underventilation of the middle ear can result in a build-up of middle ear fluid leading to middle ear disease.

    Myringotomy is a surgical procedure used to relieve pressure in the middle ear. The procedure involves creating a small hole in the eardrum so that fluid can drain from the ear or improve ventilation to the middle ear for the short term.

    If you have middle ear disease, speak with your health professional about strategies to manage it.

    A myringotomy alone as treatment option for middle ear disease is not recommended. 

  • Insertion of middle ear ventilation tubes (grommets) for otitis media with effusion

    The middle ear is a closed space that receives air via the eustachian tube. The eustachian tube is less developed in young children than in adults which sometimes means the middle air doesn’t get enough air. Underventilation of the middle ear can result in a build-up of middle ear fluid leading to middle ear disease.

    A surgeon can place a small tube in the eardrum of a child to enable air to flow through the ear.

    You should speak to your health professional if you are concerned about any ear, nose or throat symptoms your child might have. You will often be asked to keep an eye on your child and their symptoms for a period of time to help work out the best treatment.

    If treatments are unsuccessful, a specialist may advise inserting middle ear ventilation tubes.

     

Other elective surgery procedures

  • Cosmetic surgery without medical indications

    Cosmetic surgery is defined as a procedure to change features of a person that appear normal to any other individual. The intention of the procedure is to make the appearance of the person more desirable; however, there is no medical indication for the surgery.

    Cosmetic surgery does not include surgical procedures designed to improve the appearance of a person who may have body difference due to congenital defects, developmental abnormalities, trauma, infections, tumours or disease.

    It is important you speak with your healthcare provider about any concerns you have with your body that aren’t about differences. Your health professional will be able to discuss options with you. 

    Cosmetic surgery is restricted in public healthcare services.

  • Carpal tunnel release for mild symptoms

    The carpal tunnel, located on the palm side of the wrist, is formed by the carpals (bones) below and the transverse carpal ligament (tough band of tissue) above.

    The median nerve travels through the carpal tunnel and when the tunnel presses on the nerve, it can cause carpal tunnel syndrome (CTS). CTS is characterised by pain, changes to feeling and weakness in the hand.

    Carpal tunnel release is a surgical procedure where the transverse carpal ligament is cut with the aim of releasing the median nerve that is being pressed.

    Mild CTS is experienced as pain or feeling changes that come and go. It does not include muscle weakness, muscle loss or ongoing feeling loss. It does not interrupt sleep, affect the way the hand moves or have an impact on the way you can do everyday tasks.

    A carpal tunnel release should not be performed for mild CTS. Speak to your health professional about what treatment options are available for managing mild CTS. Some of them include hand therapy, splinting (making a brace for your wrist to keep it still), local steroid injections and oral medications. Often combining a number of treatments can be beneficial.

     
  • Carotid endarterectomy for asymptomatic patients

    Carotid endarterectomy (CEA) is a surgical procedure to remove the build-up of hard plaques in the carotid artery. Removing the plaques can improve blood flow to the brain and reduce the risk of stroke. The procedure is performed under general anaesthetic.

    If you have a narrow carotid artery that has not caused you any symptoms, CEA surgery is generally not recommended. Medical management is enough in most cases.

    It is important to discuss your carotid artery concerns with your health professional whether you experience symptoms or not. The risks and benefits of surgery always need to be weighed.

     
  • Cystoscopy for uncomplicated overactive bladder symptoms

    Overactive bladder (OAB) causes symptoms such as needing to go to the toilet with a sense of urgency or frequency, needing to urinate overnight and urgent incontinence without having an infection or obvious cause for it.

    Cystoscopy is a medical procedure that involves a health professional using a thin tube (inserted through the urethra) with a camera and light on the end to look inside the bladder.

    It is used to help diagnose conditions that affect the bladder and urinary system.

    If you are being investigated for OAB, so long as your urine tests have been normal and it is unlikely that you have cancer, a cystoscopy should not be performed when your health professional is initially working out the cause.

     
  • Unblocking the nasolacrimal duct in children under 12 months old

    The nasolacrimal ducts (small tubes that allow tears to drain from the eyes to the nose) can become blocked in young children. A blocked tear duct can cause watery eyes, sticky discharge, eyelid swelling/redness and infection.

    Nasolacrimal duct probing is a procedure that aims to relieve the blockage.

    Over 90 per cent of blocked eye ducts heal without the need for nasolacrimal duct probing. Therefore, this procedure should not be performed on children under 12 months of age in most circumstances.

    Speak with your health professional about what options are available for managing your child’s blocked eye duct when they are under one year old.

More information

Surgery

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Plastic and cosmetic

A-Z of surgical procedures

Content Partner

This page has been produced in consultation with and approved by: Safer Care Victoria

Last updated: December 2020

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