Best care guidance for non-urgent planned surgery

A gastroscopy is a procedure which involves inserting a flexible, thin tube down your swallowing tube, into your stomach and the first part of your intestine. The tube has a small camera on it and views the inside lining.

If you have a gastric band and are experiencing reflux, the first step your health professional should take to relieve your symptoms is release fluid from the band.

If symptoms persist, seek further advice from your health professional. A gastroscopy alongside other investigations may be recommended at this stage.

This procedure involves inserting a flexible, thin tube down your swallowing tube, into your stomach and the first part of your intestine. The tube has a small camera on it and views the inside lining.

If you have experienced long term reflux, you may experience changes to the lower part of the lining of your food track which is called Barrett’s oesophagus.

If you have Barrett’s oesophagus without dysplasia, it is recommended that you have a review gastroscopy every 3 years.

If you experience any changes in your Barrett’s or new symptoms including unexplained weight loss, pain when swallowing food, the feeling like food is sticking to your throat when swallowing or changes in reflux symptoms, speak to your health professional.

A gastroscopy is a procedure that involves inserting a thin, flexible tube down your swallowing tube, into your stomach and the first part of your intestine. The tube has a small camera on it and views the inside lining.

Dyspepsia, more commonly known as indigestion, includes symptoms affecting the mouth, throat, stomach and small intestine. Symptoms can include:

• discomfort just below your ribs
• bloating
• loss of appetite
• feeling full quickly
• burping
• nausea
• heartburn.

To treat your indigestion, your healthcare provider will usually advise you to take a 6 week course of medication in the first instance alongside making some changes to your lifestyle.

It is important to discuss indigestion that persists, worsens or recurs with your health professional. A gastroscopy to investigate your indigestion might be suggested.

A colonoscopy is a procedure which involves examining the entire large bowel with a small camera on the end of a thin, flexible tube. A surveillance colonoscopy is a procedure that is scheduled at regular intervals to review your bowel.

The interval recommended for surveillance is determined by a balance of your risk factors and the risk of the procedure itself. For a person who is determined to be of average risk, the next surveillance colonoscopy should be scheduled after 5 years. The more risk factors you have, the shorter the time before your next surveillance colonoscopy.

If you are concerned about your bowel health or you have new symptoms appear, speak with your health professional.

A colonoscopy is a procedure which involves examining the entire large bowel with a small camera on the end of a flexible, thin tube. A screening colonoscopy looks for cancerous cells in the large bowel.

For people with no bowel symptoms and who are at an average or slightly above average risk of bowel cancer (for example, including those who have only one immediate relative who was diagnosed with bowel cancer over 55 years of age), a faecal occult blood test should be the first measure used to screen for bowel cancer.

A colonoscopy is a procedure which involves examining the entire large bowel with a small camera on the end of a flexible, thin tube.

Your health professional will likely order further tests to investigate your constipation if you have not experienced any improvement in your symptoms after trialling some medication and dietary changes or if you experience worsening or progressive constipation and/or diarrhoea.

It is important to discuss your constipation or other changes to your bowel health (for example weight loss, bleeding or low blood count) with your health professional.

A colonoscopy is a procedure which involves examining the entire large bowel with a small camera on the end of a flexible, thin tube.

Diverticulitis is an infection or inflammation of the muscle of the intestine wall. A CT is a scan done to help diagnose diverticulitis.

If you have been recently diagnosed with diverticulitis via a CT scan, you do not usually need to undergo a diagnostic colonoscopy if you had a normal colonoscopy in the past two years.

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.

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.

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.

The gallbladder is a small organ within the abdomen that stores bile for digestion. Obesity and weight loss can increase the risk of gallstone disease. Gallstones are hardened deposits that develop in the gallbladder.

When a gallstone gets stuck at the outlet of the gallbladder, it can cause inflammation of the gallbladder known as cholecystitis. This can cause intense pain, nausea, vomiting and fever. A small percentage of people will need surgery to remove the gallbladder. This surgery is called a cholecystectomy.

Approximately 30 to 50% of people who have bariatric surgery (surgery relating to treatment of obesity) will develop gallstone disease. This commonly occurs within the first 6 months after surgery. For most people, gallstones will not cause complications and the gallbladder will remain healthy. In Victoria, it is not recommended to remove the gallbladder during bariatric surgery unless the patient has symptomatic gallstones.

If you are having bariatric surgery, you should discuss the risk of gallstone disease with your doctor. It is important to consider your individual needs and any risks associated with surgical procedures and medications.

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 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.

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.

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 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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

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.

In Australia, Prostate cancer is the second most common internal cancer diagnosed in men. When abnormal cells in the prostate cancer grow, they can form a malignant tumour. Prostate cancer can be found in men of varying age groups with 1 in 6 men diagnosed by the age of 85. There is no national screening program for the early detection of prostate cancer. Therefore, it is important to speak with your doctor about testing options.

Treatment of prostate cancer depends on the extent and aggressiveness of the cancer. In Australia, a radical prostatectomy or radiation therapy are the most common forms of treatment. A radical prostatectomy is a surgical procedure for the complete removal of the prostate. It is important to discuss these treatments with a urologist and a radiation oncologist to make the best choice for your individual needs.

After surgery, a doctor will regularly measure the blood level of prostate-specific antigen (PSA). The PSA level is an important tool to monitor the cancer. Many men will experience a rise in PSA, this does not always mean the cancer has returned. Changes to your PSA will be monitored, if there is a steady ongoing rise, your doctor may recommend radiation therapy.

Radiation therapy is a common form of treatment that involves high energy X-ray beams delivering a controlled dose of radiation to damage and kill cancer cells. For men who have undergone a radical prostatectomy this treatment is called postprostatectomy radiotherapy. This is defined as radiation treatment given after a period of observation following a radical prostatectomy

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.