When going through the keyhole might not always be necessary
‘The small benefit to knee patients is absent one to two years later’
The ascendancy of the technical marvels of keyhole surgery and endoscopy (where a tube with a camera is passed through the body) over the past 30 years has been nothing short of spectacular, with an almost tenfold rise in the number of gastroscopies (up from 110,000 to 937,000 a year), 14-fold for colonoscopies, eight-fold for joint arthroscopies and a five-fold increase in the number of “keyhole” operations for the gallbladder. And that, one would suppose, must be all to the good – allowing for more accurate diagnosis and speedier recovery from surgery. But how much good is debatable.
The merits of arthroscopy for those with knee afflictions might seem self-evident – permitting the surgeon to inspect the joint’s internal structure and repair any damage. But while most patients reported less pain and improved mobility at least initially, it did not seem to make much difference in the long term – an impression confirmed, if belatedly, three years ago when the outcome was compared to those allocated to “conservative treatment” (physiotherapy and anti-inflammatory drugs): “The small inconsequential benefit of knee arthroscopy is timelimited and absent one to two years later”. The number of arthroscopies has since plummeted.
The situation is rather different for those “keyhole” gallbladder operations (laparoscopic cholecystectomy) that so revolutionised surgery for those with excruciating gallstone colic, which previously required a major abdominal operation and protracted hospital stay. Still, this could scarcely account for the need for an additional 55,000 procedures a year (up from 15,000 to 70,000), suggesting perhaps it is nowadays performed too readily. And so it turns out with surgeons at Aberdeen Royal Infirmary reporting in the British Medical Journal last week that for many with gallstones the alternative of “doing nothing” is probably the better option – more than half of those in whom surgery is deferred still not having required an operation 14 years later. No doubt most gastroscopies and colonoscopies similarly are not strictly necessary.
The crying game
The alpha male too readily moved to tears prompted much interest. “I dread having to make speeches at weddings or funerals,” writes one gentleman in his seventies – while even the blatantly artificial sentimentality of schmaltzy children’s videos (watched with his two grandchildren) can cause him to “choke up”.
It is suggested this may signal the release of pent-up emotion from having been brought up to keep a “stiff upper lip” where overt demonstrations of affection were frowned upon. It can certainly be “hormonal”: “I dare not attend a carol service or watch the Armistice Day ceremony,” writes a man taking testosterone-blocking drugs for his prostate cancer.
The various antidotes proposed include mental arithmetic (“at family funerals I find factorials starting from modest numbers solves the problem”), while The Telegraph’s agony uncle Richard Madeley commends pinching the thigh. When giving an emotional speech he advises keeping the left hand in the trouser pocket: “The moment you feel yourself welling up, secretly pinch your upper thigh hard between thumb and forefinger for a good two seconds.”
Finally, a woman reports the reverse problem. “I used to cry when appropriate but for a few years have been unable to do so,” she writes. “My dearest granddaughter died at 22 just over two years ago but although I think of her often, I never feel like crying. I don’t understand it at all.”
Windy swimmer
This week’s medical query comes courtesy of Mr FR in Sussex, now in his early 70s, who likes to keep fit by swimming a couple of times a week. Recently, though, his 20 laps in the pool have been followed an hour or so later by disturbed functioning of the gut, with much flatulence and loose stools. Might anyone, he wonders, be able to cast some light on this matter?