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Do I really need surgery, or can it wait?
It depends on the condition. A few problems cannot wait: appendicitis, a trapped hernia, a blocked or perforated bowel. Some are better done on a planned date, such as gallstones that cause attacks and hernias that hurt. And some often need no operation at all: silent gallstones, most piles, most reflux and a new fissure.
In short
- Emergencies are operated on within hours.
- For most other conditions there is time to confirm the diagnosis, try simpler treatment and prepare properly.
- An operation should solve the problem you came with. Ask what it will change and what it will not.
- A second opinion is reasonable for any planned operation.
Which operations are urgent, and which can be planned?
| Condition | Usual advice | When it becomes urgent |
|---|---|---|
| Appendicitis | Operate within about a day | Always urgent |
| Blocked or perforated bowel | Hospital admission at once | Always urgent |
| Groin hernia | Planned repair if it causes symptoms; a small, symptom-free hernia in a man can be watched | Hard, painful and will not go back |
| Gallstones | No surgery if silent; planned removal after an attack of pain | Fever, jaundice or pain lasting hours |
| Acid reflux | Medicines and lifestyle; surgery for a selected group | Rarely |
| Piles | Fibre and clinic procedures; surgery for advanced grades | Heavy bleeding, or a painful clotted pile |
| Anal fissure | Ointment and stool care for six to eight weeks | Rarely |
| Anal fistula | Planned surgery; it does not close with medicines | An abscess with fever |
| Bowel cancer | Surgery within weeks, after staging | Blockage or bleeding |
What should I ask before agreeing to an operation?
What happens if I wait?
For some conditions, little changes over months. For others, the risk of an emergency rises. You should know which applies to you.
What are the alternatives?
Medicines, a clinic procedure, a change in diet or watchful waiting, and how well each works.
What will the operation change, and what will it not?
Removing the gallbladder stops gallstone pain. It does not treat bloating that had another cause.
What are the risks for me?
The risks for your age, weight and health conditions, not general figures alone.
What is recovery like?
Days in hospital, weeks off work, and restrictions on lifting or driving.
How do I decide whether to operate?
I ask four things. Is the diagnosis certain, confirmed by the right tests? Has a simpler treatment been given a proper chance where one exists? Will the operation solve the problem you came with? And are you fit and well prepared for it?
Because I also treat these conditions with medicines, diet and endoscopy, I can advise the option that fits you without a leaning toward any one of them.
How can I use the waiting time well?
If an operation is planned for some weeks ahead, the time is useful:
- Eat enough protein, and correct anaemia if you have it
- Walk every day, and practise the breathing exercises you are taught
- Bring blood sugar under control
- Stop smoking
- Lose some weight if that has been advised
People who prepare in this way have fewer complications and go home sooner.
When should I not wait?
Go to an emergency department for
- Sudden, severe abdominal pain
- A hernia that has become hard and painful and will not go back
- Vomiting with a swollen abdomen and no stool or gas
- Yellow eyes with fever and abdominal pain
- Heavy bleeding from the rectum, or vomiting blood
Questions patients ask me
Is it risky to delay a hernia repair?
For a hernia with few symptoms, the chance of the bowel becoming trapped in any given year is low, so a planned repair at a convenient time is reasonable. A painful hernia should be repaired soon.
Will my gallstones dissolve if I wait?
No. Stones do not dissolve by themselves. If they have never caused pain, they can simply be left alone. Once they have caused an attack, further attacks are likely.
I am afraid of anaesthesia. What should I do?
Say so. You will meet the anaesthetist before a planned operation, and your heart, lungs and medicines are assessed. For some operations, a spinal or local anaesthetic is an alternative.
Can I get a second opinion from you?
Yes. Bring your reports and scans. I will tell you whether I would advise the same operation, a different one, or none.
Sources
This page is written for patients and is based on the guidelines and studies below. It is for education and does not replace a consultation.
- International guidelines for groin hernia management. HerniaSurge Group. Hernia. 2018. PubMed 29330835
- European Association for the Study of the Liver guideline on gallstones. EASL. J Hepatol. 2016. PubMed 27085810
- Society of American Gastrointestinal and Endoscopic Surgeons guidelines on surgery for reflux. Slater BJ et al. Surg Endosc. 2021. PubMed 34279710
- World Society of Emergency Surgery (Jerusalem) guidelines on acute appendicitis. Di Saverio S et al. World J Emerg Surg. 2020. PubMed 32295644
- American Society of Colon and Rectal Surgeons guideline on haemorrhoids. Hawkins AT et al. Dis Colon Rectum. 2024. PubMed 38294832