Patient guide to gynaecological surgery | |
Do you really need surgery? A sensible guide to hysterectomy and other procedures. |
This patient guide is the result of a collaboration between two female doctors, one from the US and one from Australia. Much of the book deals with hysterectomy. There are chapters on “traditional hysterectomy” and the risks of traditional hysterectomy after surgery, and laparoscopic hysterectomy. However, there are also chapters dealing with pathology (what goes wrong) and the risks of laparoscopy and other endoscopic surgery. The authors use case studies to illustrate the points in each chapter and, while this is a novel approach, there are so many of them that it is confusing to the reader. The book has an unusual title — Do you really need surgery? This would lead the reader to expect a greater discussion of the alternatives to hysterectomy and other common gynaecological procedures. Only one of the 17 chapters deals with the alternatives to surgery and only the last chapter deals with the question asked by the title. Some of the information presented is misleading and much of it lacks any evidence base. For example, dysfunctional uterine bleeding is the most common reason for hysterectomy, yet there is only half a page on this topic. This contrasts with the section on prolapse, which is two pages long. In the chapter on the non-surgical treatment of gynaecological problems there is the recommendation to use the oral contraceptive pill, luteal-phase progestagens and danazol. In particular, there are recommendations to prescribe luteal-phase progestagens to manage bleeding symptoms. In fact, randomised controlled trials of this intervention have demonstrated an increase in menstrual bleeding. Danazol is described as the primary medical treatment for endometriosis. Although some of the side effects of danazol are mentioned, the androgenic side effects of acne and weight gain are surprisingly omitted. I was surprised that there were not more statistics provided to help patients make decisions. In particular, information on the success rates of the various procedures, and how common the associated complications are, would have been useful. Where they are given they seem to be inaccurate and misleading. For example, the section on endometrial ablation or resection mentions a 1%-2% perforation rate. Endometrial ablation by balloon or microwave has a much lower complication rate. This is mentioned in the next section but would be confusing for many women. This is not a book that I would recommend to my patients. It attempts to cover too much and does not provide information all in one place. I would recommend that my patients read one of the pamphlets on specific conditions or procedures. For example, the RANZCOG leaflet on heavy menstrual bleeding, or the one on hysterectomy, covers all the options comprehensively. Cynthia M Farquhar
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