Polypper (adenoider), mandler og galdeblæren er organer, der ikke bør fjernes; korrektion af kosten bør være grundlaget for behandlingen.
Oprindeligt udsagn
انتقد إزالة الزوائد اللحمية واللوزتين والمرارة، معتبراً إياها أعضاء لا يجب استئصالها، ودعا إلى تصحيح النظام الغذائي كأساس للعلاج.
ikke ordret – parafrase. Oversættelse ved projektet; den arabiske ordlyd er gældende.
Oversættelse
Polypper (adenoider), mandler og galdeblæren er organer, der ikke bør fjernes; korrektion af kosten bør være grundlaget for behandlingen.
Oprindelse
- Kildestatus
- Citat fra arkivet (uden kildeangivelse)
- Tilskrivning
- Elawady (archive paraphrase; source video not given)
- Oprindelse
- https://eltayebat.com/rule/unnecessary-organ-removal/
- Usikkerhed om tilskrivningen
- The archive attributes this text to Dr. Diaa in its 'د. ضياء يقول' box but gives no video reference. Transcript check (the project's research files, keyword search of 307 archive transcripts): similar_idea_only. Criticism of removing tonsils and adenoids is found (F6BNXMxnfYY; a parent's narration in HF8hrBdMV6E). For the gallbladder he discusses consequences of removal (iDwPxhaqof4) rather than stating that it must not be removed. The general statement that these organs 'should not be excised' was not found as such.
- Påstået mekanisme
These are functioning (lymphoid/storage) organs; disease arises from wrong food.
- Påstået helbredseffekt
Removal causes harm; diet prevents/treats.
- Berørt befolkningsgruppe
Children and adults
- Geografisk afgrænsning hos Elawady
none found
Afvigende kildeversioner
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! الدراسات اللي ينشرها لمعرفة مدي تخبط الطب حتي ٢٠٢٥ (Åbn kilde)
- Offentliggjort
- 26. juli 2025
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live!عرق النسا (Åbn kilde)
- Offentliggjort
- 28. december 2025
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- انتفاخ القولون وعلاقته بآلام الظهر وعرق النسا وباقي أعراض جسمك (Åbn kilde)
- Offentliggjort
- 13. marts 2026
- Tidsstempel
- ikke tilgængeligt (transskriptionen har ingen tidsangivelser)
- Usikkerhed om tilskrivningen
- Archive transcript (YouTube CC or AI-generated); wording may contain transcription errors; no timestamps available.
اللي بيشيل المراره ما ياخدش ما ياخدش املاح مراريه المراره اما اتشالت عملت مشكله واحده بس ان انت الاملاح
Whoever has the gallbladder removed does not get bile salts; when the gallbladder was removed it created only one problem, that the salts...
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- Dr Diaa Al Awady د ضياء العوضي is live! تحليل الدهون (Åbn kilde)
- Offentliggjort
- 28. juli 2025
- Tidsstempel
- 0:42:37 (placering i den originale videos automatiske YouTube-undertekstspor; bekræfter, hvor ordene forekommer, ikke hvem der taler)
- Usikkerhed om tilskrivningen
- Archive transcript (YouTube CC or AI-generated); no timestamps; YouTube original not checked; wording may contain recognition errors. Similar idea only (consequences of gallbladder removal, not a statement that it must not be removed).
يوم ما خلفته هو ادوار برد ما بتبطلش شلت له اللوز واللحميه
Since the day I had him, he has had colds that never stop; I had his tonsils and adenoids removed...
- Kildestatus
- Videotransskription (egne ord)
- Tilskrivning
- Elawady (machine transcript)
- Video
- الرزق. المناعه. الحقيقه والسراب (Åbn kilde)
- Offentliggjort
- 4. december 2025
- Tidsstempel
- 0:29:51 (placering i den originale videos automatiske YouTube-undertekstspor; bekræfter, hvor ordene forekommer, ikke hvem der taler)
- Usikkerhed om tilskrivningen
- Archive transcript (YouTube CC or AI-generated); no timestamps; YouTube original not checked; wording may contain recognition errors. Narrated story of a parent (speaker attribution uncertain); illustrates the criticism of tonsil/adenoid removal.
Videnskabelig vurdering
Overvejende falsk – Væsentlige dele af udsagnet er ikke understøttet af evidensen eller er stærkt overdrevne.
Evidensens sikkerhed: moderat – Yderligere forskning kan stadig påvirke vurderingen.
1. Hvad blev der påstået?
That tonsils, adenoids and gallbladder should not be removed and diet is the basis of treatment.
2. Hvad er påviseligt korrekt?
Correct that these operations are sometimes done without strong indication and that watchful waiting is often appropriate: guidelines recommend watchful waiting for recurrent throat infections below 7/5/3 episodes per year (I-ORG-06); benefit of tonsillectomy for recurrent tonsillitis in children is modest (0.6 fewer episodes in first year, I-ORG-04); conservative management of uncomplicated symptomatic gallstones was not worse on the primary generic pain outcome, overall complications or further treatment at 24 months, and the authors conclude that observation may be cost-effective in selected patients (I-ORG-09); in the children's sleep-apnoea trial, 46% normalised with watchful waiting and the authors state that medical management and reassessment after observation may be a valid option (A-ORG-03); removal carries risks (bleeding 19%, I-ORG-05; post-cholecystectomy diarrhoea 13.3%, A-ORG-09).
3. Hvad er forkert eller overdrevet?
As a blanket rule it is wrong: adenotonsillectomy normalized sleep studies in 79% vs 46% of children with OSA (A-ORG-03); in adults with recurrent tonsillitis it halved sore-throat days (I-ORG-05); about 30% of gallstone patients managed conservatively needed surgery within 2 years and gallstone-specific quality of life was better with surgery (I-ORG-09). No evidence was found that diet treats these conditions.
4. Hvad er stadig uklart?
Long-term immune consequences of childhood tonsillectomy (A-ORG-01) remain uncertain because of confounding.
5. Hvilke studier understøtter det?
A-ORG-01, I-ORG-04, I-ORG-06; A-ORG-09 documents a harm relevant for consent (post-cholecystectomy diarrhoea 13.3%, partly transient) but has no comparison with non-operative management and does not show that surgery should be avoided.
6. Hvilke studier modsiger det?
A-ORG-03 (contradicts a blanket 'never remove' rule but partly supports a conservative-first approach for mild-moderate OSA), I-ORG-05, I-ORG-09 (limiting: supports watchful waiting for selected uncomplicated cases, not refusal of surgery when indicated).
7. Hvad gælder i Tyskland og Europa?
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
8. Hvad vides om Egypten?
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
9. Hvilken praktisk konklusion er passende?
Det centrale spørgsmål er „indiceret eller unødvendig“, ikke „fjerne eller aldrig fjerne“. Afventende observation er rimelig i lette tilfælde; operation er gavnlig ved klare indikationer.
Detaljer om vurderingen
- Begrundelse for evidensens sikkerhed
RCTs and Cochrane reviews show benefits of surgery in defined indications; no evidence was identified that diet correction treats tonsillar hypertrophy, OSA or symptomatic gallstones.
- Kildekvalitet
Archive paraphrase; consistent with several transcripts.
- Regional overførbarhed
Applicable.
- Individuelle undtagelser
Many children with mild recurrent sore throat improve without surgery; watchful waiting is the guideline default below set thresholds.
- Påstandens regionale rækkevidde
- generel (biologisk/medicinsk)
- Senest gennemgået
- 26. oktober 2026 foreløbig
Videnskabelig evidens i detaljer
Overfortolket – Der findes et reelt fund, men påstanden udleder mere af det, end data tillader (f.eks. sammenhæng tolket som årsag, dyredata overført til mennesker, lille effekt fremstillet som stor).
Forskningsspørgsmål: In children with adenotonsillar hypertrophy (recurrent tonsillitis or obstructive sleep apnoea) and in adults with gallstone disease, does avoiding removal of tonsils/adenoids/gallbladder and relying on diet correction lead to outcomes as good as surgery when surgery is indicated?
Forskningsspørgsmål i detaljer (PICO)
- Population
- Children with recurrent throat infection or sleep-disordered breathing; adults with symptomatic or complicated gallstones
- Intervention eller eksponering
- No surgery / diet correction as basis of treatment (the claim); watchful waiting as the closest tested alternative
- Sammenligning
- (Adeno)tonsillectomy; cholecystectomy
- Geografisk rækkevidde
- universal biology; practice patterns vary by country
- Effektmål
- Symptoms and quality of life
- PSG normalisation / progression
- Sore-throat days
- Gallstone complications and pain
- Surgical harms
Studieresultater som rapporteret af forfatterne. Vores vurdering følger nedenfor.
Hvad taler for påstanden?
Tonsil and adenoid surgery for children who snore or have sleep apnoea
Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2 Systematisk reviewabstract kontrolleretnyligt tilføjetCochrane review: in children with mild-moderate OSA, 46% normalised with watchful waiting within 7 months; surgery did not improve cognition.
- Faktisk resultat
- PSG normalisation 79% vs 46% (RD 33%, 24-42%); no benefit on attention/neurocognition.
- Metodisk kvalitet
- high (Cochrane, one large low-risk RCT)
- Relevans
- direct: supports conservative-first for mild OSA
- Begrænsninger
- Short follow-up; no data under age 5.
UK trial: remove the gallbladder or wait?
Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104 Randomiseret kontrolleret forsøgfuldtekst, struktureret vurdering af risiko for biasC-GALL RCT: observation of uncomplicated symptomatic gallstones was not worse on generic pain at 24 months; 29.5% needed surgery.
- Faktisk resultat
- SF-36 bodily pain AUC MD -0.0 (-1.7 to 1.7); complications 14.7% vs 21.2%.
- Metodisk kvalitet
- high (multicentre RCT)
- Relevans
- direct for uncomplicated symptomatic gallstones
- Begrænsninger
- Gallstone-specific QoL better with surgery; excluded complicated disease.
US guideline on tonsil surgery in children
Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757 Retningslinje / holdningspapirabstract kontrolleretAAO-HNS guideline: watchful waiting is the standard for recurrent throat infection below 7/5/3 episodes per year.
- Faktisk resultat
- Strong recommendation (key action statement).
- Metodisk kvalitet
- high (guideline)
- Relevans
- direct
- Begrænsninger
- US guideline.
Hvad taler imod påstanden?
Trial: tonsil/adenoid surgery for children with sleep apnea
Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881 Randomiseret kontrolleret forsøgfuldtekst, struktureret vurdering af risiko for biasCHAT RCT: adenotonsillectomy improved symptoms, behaviour, QoL and sleep studies versus watchful waiting.
- Faktisk resultat
- PSG normalisation 79% vs 46%; PSQ-SRBD ES 1.50.
- Metodisk kvalitet
- high (RCT, full text)
- Relevans
- direct
- Begrænsninger
- Primary cognitive outcome negative.
UK trial: tonsil removal in adults with repeated tonsillitis
Wilson JA et al.. Lancet 2023 · PMID 37209706 · DOI 10.1016/S0140-6736(23)00519-6 Randomiseret kontrolleret forsøgfuldtekst, struktureret vurdering af risiko for biasNATTINA RCT: tonsillectomy in adults with recurrent tonsillitis roughly halved sore-throat days over 2 years.
- Faktisk resultat
- IRR 0.53 (0.43-0.65); bleeding 19%.
- Metodisk kvalitet
- high (RCT)
- Relevans
- direct
- Begrænsninger
- Adults only; harms considerable.
Tonsil surgery for children who snore but have only mild apnoea
Redline S et al.. JAMA 2023 · PMID 38051326 · DOI 10.1001/jama.2023.22114 Randomiseret kontrolleret forsøgabstract kontrolleretnyligt tilføjetPATS RCT: in mild SDB, surgery improved behaviour, symptoms, QoL and blood pressure and prevented progression of apnoea.
- Faktisk resultat
- Progression to AHI > 3: 1.3% vs 13.2%.
- Metodisk kvalitet
- high (RCT)
- Relevans
- direct
- Begrænsninger
- Primary cognitive outcomes negative.
Hvad siger den samlede evidens?
Redaktionel vurdering på grundlag af studierne ovenfor – ikke selv et studieresultat.
Hvilken position er bedst underbygget?
Surgery has clear benefit in defined indications (OSA with symptoms, frequent severe tonsillitis, symptomatic or complicated gallstones); watchful waiting is a valid, guideline-endorsed option for mild cases. No evidence was found that diet correction treats tonsillar hypertrophy, OSA or gallstone disease.
Hvorfor nogle studier vejer tungere
RCTs and Cochrane reviews (CHAT, PATS, NATTINA, C-GALL, Cochrane 2014/2015) outweigh registry associations (Byars) for the question 'should these organs be removed'.
Er en årsagssammenhæng påvist? Ja, påvist RCTs establish the benefits of indicated surgery and the natural improvement of many mild cases.
Resterende usikkerhed
Long-term immune consequences of childhood tonsillectomy; best selection criteria for gallbladder surgery.
Begrundet konklusion
Caution and watchful waiting are justified for mild cases; a general rule never to remove these organs, and diet as the basis of treatment, are not supported.
Hvorfor ser studierne ud til at være uenige?
Apparent conflict between trials showing benefit of surgery and trials showing watchful waiting is reasonable is explained by disease severity: benefit is clearest in established OSA and frequent infections, smallest in mild disease (PATS, KATE). For gallstones, C-GALL and SECURE show that observation or stricter selection is reasonable in uncomplicated cases, while complicated disease (cholecystitis, pancreatitis, CBD stones) is excluded from these trials and treated surgically in all guidelines.
Afhænger det af landet?
- Generelle biologiske virkninger
- Benefits and risks of these operations are universal.
- Spisevaner
- No evidence links specific diets to tonsillar hypertrophy or gallstone treatment.
- Fødevarens oprindelse
- Not applicable.
- Forurenende stoffer
- Not applicable.
- Nationale produktionsforhold
- Not applicable.
- Retsregler
- Not applicable.
- Faktiske overvågningsdata
- No Egypt-specific data on rates or outcomes of these operations were found (PubMed search for Egyptian tonsillectomy outcome studies: 1 irrelevant hit).
En regional forskel, der ændrer konklusionen, er ikke understøttet af robuste data.
Statistisk genberegning
- Recalculate CHAT risk difference and NNT from counts – RD 33.1% (24.1-42.0%), NNT 3 - matches report genberegnet
- Absolute difference for progression to AHI > 3 – -11.9 points by subtraction (reported -11.2%, model-based); NNT about 8 genberegnet
- Operation-rate difference and pain-free proportions – -8.4 points (NNT about 12 to avoid one operation); ~36% still in pain after surgery genberegnet
Sikkerheden af den samlede evidens (GRADE, forenklet)
- Primært effektmål
- Symptom control / QoL with surgery vs non-surgical management in indicated cases
- Udgangsniveau
- høj (randomiserede forsøg)
- Grunde til nedgradering
- indirectness (diet correction itself never tested)
- inconsistency by severity
- Resultat
- moderat
Forenklet vurdering ved én bedømmer efter GRADE-tilgangen; ikke et formelt GRADE-panel. GRADE vurderer den samlede evidens for ét effektmål, ikke enkelte studier.
Kontrollerede kliniske retningslinjer og officielle udtalelser
- AAO-HNS Foundation: Clinical Practice Guideline: Tonsillectomy in Children (Update) (2019) · Original publikation
Strong recommendation for watchful waiting for recurrent throat infection below 7/5/3 episodes per year in the past 1/2/3 years; modifying factors may favour surgery; polysomnography before tonsillectomy for obstructive sleep-disordered breathing in high-risk children; tonsillectomy is a treatment option for obstructive sleep-disordered breathing with tonsillar hypertrophy (abstract key action statements; registered as I-ORG-06). - NICE: Gallstone disease: diagnosis and management (CG188), Recommendations (2014) · Original publikation
Reassure people with asymptomatic gallbladder stones that they need no treatment unless symptoms develop; offer laparoscopic cholecystectomy for symptomatic gallbladder stones; early cholecystectomy within 1 week for acute cholecystitis; bile duct clearance plus cholecystectomy for common bile duct stones (I-ORG-141). - Tokyo Guidelines (TG18): Tokyo Guidelines 2018: flowchart for the management of acute cholecystitis (2018) · Original publikation
Abstract: early laparoscopic cholecystectomy recommended for Grade I and (with experienced surgeons) Grade II acute cholecystitis in fit patients; for patients unsuitable for early surgery, early/urgent biliary drainage followed by delayed cholecystectomy. Erratum published 2019. - EASL: EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones (2016) · Original publikation kunne ikke hentes; indholdet er ikke brugt
Søgestrategi
Dokumenterede litteratursøgninger til denne gennemgang (søgestrenge i databasens originale syntaks).
| Database | Dato | Søgning | Søgt efter | Hits | Inkluderet |
|---|---|---|---|---|---|
| Europe PMC | 26. oktober 2026 | (TITLE:"tonsillectomy" OR TITLE:"adenotonsillectomy") AND (TITLE:"sleep apnoea" OR TITLE:"sleep apnea" OR TITLE:"sleep-disordered") AND (TITLE:"meta-analysis" OR TITLE:"systematic review" OR JOURNAL:"Cochrane Database Syst Rev") | begge retninger | 50 | |
| Europe PMC | 26. oktober 2026 | (watchful waiting OR "non-surgical" OR conservative) AND (tonsillectomy OR adenotonsillectomy) AND children AND (TITLE:randomised OR TITLE:randomized) AND PUB_YEAR:[2015 TO 2026] | understøttende evidens | 26 | |
| Europe PMC | 26. oktober 2026 | JOURNAL:"Cochrane Database Syst Rev" AND (TITLE:tonsillectomy OR TITLE:adenoidectomy OR TITLE:adenotonsillectomy) | begge retninger | 32 | |
| PubMed | 26. oktober 2026 | adenotonsillectomy[ti] AND (watchful waiting[tiab] OR observation[tiab]) AND randomized controlled trial[pt] | understøttende evidens | 41 | |
| Europe PMC | 26. oktober 2026 | (TITLE:gallstones OR TITLE:cholelithiasis OR TITLE:cholecystectomy) AND (TITLE:randomised OR TITLE:randomized) AND (conservative OR observation OR restrictive OR "watchful waiting") | understøttende evidens | 201 | |
| PubMed | 26. oktober 2026 | (cholecystectomy[ti]) AND (conservative management[tiab] OR watchful waiting[tiab] OR observation[tiab]) AND (systematic review[pt] OR meta-analysis[pt]) | begge retninger | 11 | |
| PubMed | 26. oktober 2026 | tonsillectomy children clinical practice guideline update 2019 | retningslinjer | 7 | |
| PubMed | 26. oktober 2026 | "EASL Clinical Practice Guidelines on the prevention, diagnosis and treatment of gallstones" | retningslinjer | 1 | |
| PubMed | 26. oktober 2026 | Tokyo Guidelines 2018 flowchart management acute cholecystitis | retningslinjer | 3 | |
| PubMed | 26. oktober 2026 | (tonsillectomy[ti] OR adenotonsillectomy[ti]) AND (Egypt[tiab] OR Egyptian[tiab]) AND (indications OR outcome OR rate) | begge retninger | 1 |
Åbne spørgsmål
Long-term outcomes of watchful waiting in children under 5; selection criteria for cholecystectomy.
Hvor grundigt blev dette kontrolleret?
11 tilknyttede studier: 5 kontrolleret i fuldtekst (heraf 4 med en struktureret vurdering af risiko for bias), 6 på grundlag af abstractet, 0 kun bibliografisk. Der har endnu ikke fundet en formel vurdering med to uafhængige bedømmere sted, og heller ingen uafhængig menneskelig ekspertgennemgang.
Seneste videnskabelige gennemgang: 26. oktober 2026
Vurderingens historik
- 25. oktober 2026 · Fase 1 · Første vurdering: Overvejende falsk (moderat)
- 26. oktober 2026 · Fase 4 (systematisk evidensgennemgang) · Undersøgt igen med udvidet evidens; vurdering uændret: Overvejende falsk (moderat)
Unchanged. New trials (PATS, KATE, SECURE) strengthen the correct part of the claim (watchful waiting/selective surgery is reasonable in mild disease) but do not change the conclusion that a blanket rule against removal and diet-based treatment is unsupported.
Nye kilder: I-ORG-103 I-ORG-101 I-ORG-102 I-ORG-104
På almindeligt sprog
Arkivet beretter, at Elawady var imod fjernelse af polypper, mandler og galdeblære og i stedet anbefalede at rette op på kosten. En del af dette er i tråd med medicinske retningslinjer: mange børn med lejlighedsvis ondt i halsen har ikke brug for operation, og nogle patienter med galdesten kan vente. Men for børn med søvnapnø, voksne med hyppig halsbetændelse eller personer med gentagne galdestensanfald viser forsøg en klar gavn af operation. Vi fandt ingen evidens for, at kost alene behandler disse tilstande.
Studier om denne påstand
Studier, der understøtter påstanden (4)
-
Danish children: tonsil/adenoid removal and later illness
Byars SG et al.. JAMA Otolaryngol Head Neck Surg 2018 · PMID 29879264 · DOI 10.1001/jamaoto.2018.0614Kohortestudieciteret af Tayebat-arkivetabstract kontrolleret★ nøglestudieChildren who had the operations had more respiratory illnesses later (2-3 times for upper airway disease), but the study cannot prove the operation caused it.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: moderat · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Long-term risk
- Hvordan blev studiet udført?
Register cohort
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
1.19 million
- Hvad blev der faktisk fundet?
Associations with later respiratory/infectious/allergic disease
- Hvor stor var den observerede effekt?
RR 1.99-2.72; infections +2.14% absolute
- Hvad betyder resultaterne i hverdagen?
A reason to avoid unnecessary operations
- Hvilke begrænsninger har studiet?
Confounding
- Hvad siger det om Elawadys konkrete påstand?
Supports a cautious approach, not a ban
- Gælder resultaterne for Tyskland og Europa?
Directly European
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
That surgery causes the diseases
-
Cochrane review: tonsil removal for repeated throat infections
Burton MJ et al.. Cochrane Database Syst Rev 2014 · PMID 25407135 · DOI 10.1002/14651858.CD001802.pub3Systematisk reviewuafhængig krydstjekabstract kontrolleret★ nøglestudieSurgery reduced sore throats modestly in the first year (about 0.6 episodes fewer in children); many children get better without surgery.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Effectiveness
- Hvordan blev studiet udført?
Cochrane review
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
1143
- Hvad blev der faktisk fundet?
Modest benefit
- Hvor stor var den observerede effekt?
0.6 fewer episodes
- Hvad betyder resultaterne i hverdagen?
Surgery helps a little, mainly in severe cases
- Hvilke begrænsninger har studiet?
Short follow-up
- Hvad siger det om Elawadys konkrete påstand?
Supports caution, not a ban
- Gælder resultaterne for Tyskland og Europa?
Applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Long-term effects
-
US guideline on tonsil surgery in children
Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757Retningslinje / holdningspapiruafhængig krydstjekabstract kontrolleretWatchful waiting is recommended unless infections are very frequent; surgery is recommended for documented sleep apnea.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Indications
- Hvordan blev studiet udført?
Guideline
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
n/a
- Hvad blev der faktisk fundet?
Clear thresholds
- Hvor stor var den observerede effekt?
n/a
- Hvad betyder resultaterne i hverdagen?
Not every child needs surgery; some clearly do
- Hvilke begrænsninger har studiet?
US
- Hvad siger det om Elawadys konkrete påstand?
Partly aligns
- Gælder resultaterne for Tyskland og Europa?
Similar principles
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Individual decisions
-
Waiting versus surgery in toddlers with mild sleep apnoea
Sjölander I et al.. JAMA Otolaryngol Head Neck Surg 2025 · PMID 40965870 · DOI 10.1001/jamaoto.2025.2831Randomiseret kontrolleret forsøguafhængig krydstjekabstract kontrolleretAfter 3 years, waiting was about as good as surgery on sleep tests, but 42% of the waiting group ended up having surgery.
Supports watchful waiting in mild OSA with small tonsils; 42% still needed surgery.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: lav · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Compare surgery with waiting in 2-4-year-olds
- Hvordan blev studiet udført?
Small randomised trial with 3-year follow-up
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
60 Swedish children
- Hvad blev der faktisk fundet?
No difference in sleep-study change; symptoms favoured surgery; 42% crossed over
- Hvor stor var den observerede effekt?
Cohen d 0.05 for OAHI
- Hvad betyder resultaterne i hverdagen?
Mild cases with small tonsils can often wait
- Hvilke begrænsninger har studiet?
Very small, per-protocol analysis
- Hvad siger det om Elawadys konkrete påstand?
Partly supports caution; does not support a 'never' rule
- Gælder resultaterne for Tyskland og Europa?
Directly applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Cannot show equivalence
Intet studie i denne gruppe er markeret som nøglestudie.
Studier, der modsiger eller begrænser påstanden (3)
-
Trial: tonsil/adenoid surgery for children with sleep apnea
Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881Randomiseret kontrolleret forsøgciteret af Tayebat-arkivetfuldtekst, struktureret vurdering af risiko for biasSurgery normalized sleep studies in 79% vs 46% with waiting and improved behaviour and quality of life.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Nej · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
OSA treatment
- Hvordan blev studiet udført?
RCT
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
464
- Hvad blev der faktisk fundet?
Symptom, QoL and sleep-study benefit; no cognitive benefit; 46% normalized with waiting
- Hvor stor var den observerede effekt?
79% vs 46%
- Hvad betyder resultaterne i hverdagen?
Surgery helps children with sleep apnea
- Hvilke begrænsninger har studiet?
7 months
- Hvad siger det om Elawadys konkrete påstand?
Contradicts blanket rejection of surgery, but supports watchful waiting as a valid option for many children
- Gælder resultaterne for Tyskland og Europa?
Applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Long-term cognition
-
UK trial: tonsil removal in adults with repeated tonsillitis
Wilson JA et al.. Lancet 2023 · PMID 37209706 · DOI 10.1016/S0140-6736(23)00519-6Randomiseret kontrolleret forsøguafhængig krydstjekfuldtekst, struktureret vurdering af risiko for bias★ nøglestudieSurgery roughly halved sore-throat days over 2 years, but 19% had bleeding complications.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Nej · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Adult tonsillitis
- Hvordan blev studiet udført?
RCT
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
453
- Hvad blev der faktisk fundet?
Fewer sore-throat days
- Hvor stor var den observerede effekt?
IRR 0.53
- Hvad betyder resultaterne i hverdagen?
For frequent tonsillitis, surgery helps despite risks
- Hvilke begrænsninger har studiet?
Open label; self-reported outcome; many switched groups; missing weekly data
- Hvad siger det om Elawadys konkrete påstand?
Contradicts 'should not be removed'
- Gælder resultaterne for Tyskland og Europa?
European
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Very long-term risks
-
UK trial: remove the gallbladder or wait?
Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104Randomiseret kontrolleret forsøguafhængig krydstjekfuldtekst, struktureret vurdering af risiko for bias★ nøglestudieOver 18 months general pain scores were similar, but about 30% of the 'wait' group needed surgery, 11.5% had gallstone complications before surgery, and gallstone-specific quality of life was better after surgery.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Gallstone management
- Hvordan blev studiet udført?
RCT
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
434
- Hvad blev der faktisk fundet?
Similar general QoL; better gallstone QoL with surgery
- Hvor stor var den observerede effekt?
Difference 9.0 condition-specific
- Hvad betyder resultaterne i hverdagen?
Waiting can be an option, but gallstones do cause symptoms
- Hvilke begrænsninger har studiet?
Short follow-up; many crossovers; unblinded; many questionnaires missing later
- Hvad siger det om Elawadys konkrete påstand?
Contradicts 'gallstones cause no symptoms'
- Gælder resultaterne for Tyskland og Europa?
European
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Long-term outcomes
Intet studie i denne gruppe er markeret som nøglestudie.
Studier med blandede eller uklare resultater (4)
-
Diarrhoea after gallbladder removal
Farrugia A et al.. BMJ Open 2022 · PMID 35177439 · DOI 10.1136/bmjopen-2020-046172Systematisk reviewciteret af Tayebat-arkivetfuldtekst, struktureret vurdering af risiko for biasAbout 13% of patients developed diarrhoea after the operation.
Adenoids, tonsils and the gallbladder are organs that should not be removed; correcting the diet should be the foundation of treatment.
Understøtter studiet den konkrete påstand? Ja · Metodisk kvalitet: lav · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
PCD rate
- Hvordan blev studiet udført?
Systematic review
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
3476
- Hvad blev der faktisk fundet?
13.3%
- Hvor stor var den observerede effekt?
13.3%
- Hvad betyder resultaterne i hverdagen?
A common side effect to discuss before surgery
- Hvilke begrænsninger har studiet?
Crude pooling of heterogeneous, mostly uncontrolled studies; rates 2-57%; no standard definition
- Hvad siger det om Elawadys konkrete påstand?
Supports informed consent
- Gælder resultaterne for Tyskland og Europa?
Applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Causes; exact rate; whether the gallbladder should be kept; that more dietary fat helps
-
Tonsil and adenoid surgery for children who snore or have sleep apnoea
Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2Systematisk reviewuafhængig krydstjekabstract kontrolleret★ nøglestudieSurgery normalised sleep studies in 79% versus 46% with watchful waiting and improved symptoms, but did not improve attention or thinking tests.
Shows benefit of surgery for OSA (against 'never remove') but 46% normalise with watchful waiting (supports caution).
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Compare tonsil/adenoid removal with no surgery in children with sleep-disordered breathing
- Hvordan blev studiet udført?
Cochrane systematic review of randomised trials
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
3 trials, 562 children
- Hvad blev der faktisk fundet?
Better symptoms, quality of life and sleep studies after surgery; no gain in cognition; many untreated children improved
- Hvor stor var den observerede effekt?
PSG normalisation RD 33% (24-42%); OSA-18 MD -17.7
- Hvad betyder resultaterne i hverdagen?
For children with sleep apnoea, surgery helps symptoms, but waiting and re-checking is a reasonable option in mild cases
- Hvilke begrænsninger har studiet?
Few trials, short follow-up, no data under age 5
- Hvad siger det om Elawadys konkrete påstand?
Supports caution but not a rule that tonsils must never be removed
- Gælder resultaterne for Tyskland og Europa?
Directly applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Cannot say anything about diet as a treatment; not tested
-
Tonsil surgery for children who snore but have only mild apnoea
Redline S et al.. JAMA 2023 · PMID 38051326 · DOI 10.1001/jama.2023.22114Randomiseret kontrolleret forsøguafhængig krydstjekabstract kontrolleret★ nøglestudieSurgery did not improve thinking or attention after a year but did improve behaviour, symptoms and quality of life.
Watchful waiting did not harm cognition (supports caution) but surgery improved symptoms, QoL and prevented progression (against a 'never' rule).
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Test early surgery versus waiting in children with mild sleep-disordered breathing
- Hvordan blev studiet udført?
Randomised trial, 12 months
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
459 children aged 3-12 in the USA
- Hvad blev der faktisk fundet?
No cognitive benefit; better symptoms, QoL and blood pressure with surgery
- Hvor stor var den observerede effekt?
AHI progression 1.3% vs 13.2%
- Hvad betyder resultaterne i hverdagen?
Waiting is reasonable for mild cases, surgery helps symptoms
- Hvilke begrænsninger har studiet?
Unblinded subjective outcomes; short follow-up
- Hvad siger det om Elawadys konkrete påstand?
Partly supports caution; does not support 'never operate' or diet as treatment
- Gælder resultaterne for Tyskland og Europa?
Directly applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Nothing about diet
-
Fewer gallbladder operations by stricter selection
Comes DJ et al.. JAMA Surg 2024 · PMID 39167382 · DOI 10.1001/jamasurg.2024.3080Randomiseret kontrolleret forsøguafhængig krydstjekfuldtekst kontrolleret★ nøglestudieA stricter selection avoided about 8 in 100 operations without more complications, but about a third of patients still had pain after surgery in both groups.
Supports more selective surgery for uncomplicated gallstones; does not support a rule never to operate.
Understøtter studiet den konkrete påstand? Delvist · Metodisk kvalitet: høj · Evidensens sikkerhed: se den samlede vurdering af påstanden
Original publikation · Videnskabelige detaljer
Studiet forklaret enkelt
- Hvad ville forskerne finde ud af?
Test whether stricter selection for gallbladder surgery is safe in the long term
- Hvordan blev studiet udført?
Randomised trial with 5-year follow-up
- Hvor mange mennesker, dyr eller prøver blev undersøgt?
1067 Dutch adults with gallstones and abdominal pain
- Hvad blev der faktisk fundet?
Fewer operations, no more complications; only about two thirds pain free in both groups
- Hvor stor var den observerede effekt?
Operation rate 73.2% vs 81.5%
- Hvad betyder resultaterne i hverdagen?
Gallstones are not always the cause of pain; surgery should be well indicated
- Hvilke begrænsninger har studiet?
Protocol deviations and missing survey data
- Hvad siger det om Elawadys konkrete påstand?
Partly supports caution, not a ban on surgery
- Gælder resultaterne for Tyskland og Europa?
Directly applicable
- Hvad kan der udtrykkeligt ikke sluttes af dette studie?
Cannot say that untreated symptomatic gallstones are harmless
Intet studie i denne gruppe er markeret som nøglestudie.
Regional kontekst
Tyskland / EU
Most cited cohorts are Scandinavian (Denmark, Sweden) and directly European; RCTs from the UK and Finland are directly transferable. Guidelines in Europe also emphasize defined indications (not verified here in detail).
Egypten
No Egypt-specific data on rates or outcomes of tonsillectomy, cholecystectomy, hysterectomy, splenectomy or thyroid surgery were identified in this review.
Hvad gælder i mit land?
Generel videnskabelig vurdering
Overvejende falsk Forsigtighed over for unødvendig kirurgi er berettiget; en generel regel om aldrig at fjerne disse organer er det ikke.
Dette udsagn vedrører biologiske eller medicinske sammenhænge. Den videnskabelige vurdering ovenfor gælder uanset land; landespecifikke fødevaredata ændrer ikke ved den.
Referencer
- Association of Long-Term Risk of Respiratory, Allergic, and Infectious Diseases With Removal of Adenoids and Tonsils in Childhood.. Byars SG et al.. JAMA Otolaryngol Head Neck Surg 2018 · PMID 29879264 · DOI 10.1001/jamaoto.2018.0614
- Tonsillectomy or adenotonsillectomy versus non-surgical treatment for chronic/recurrent acute tonsillitis.. Burton MJ et al.. Cochrane Database Syst Rev 2014 · PMID 25407135 · DOI 10.1002/14651858.CD001802.pub3
- Clinical Practice Guideline: Tonsillectomy in Children (Update).. Mitchell RB et al.. Otolaryngol Head Neck Surg 2019 · PMID 30798778 · DOI 10.1177/0194599818801757
- Adenotonsillectomy vs Watchful Waiting in Pediatric Mild to Moderate Obstructive Sleep Apnea: The KATE Randomized Clinical Trial.. Sjölander I et al.. JAMA Otolaryngol Head Neck Surg 2025 · PMID 40965870 · DOI 10.1001/jamaoto.2025.2831
- A randomized trial of adenotonsillectomy for childhood sleep apnea.. Marcus CL et al.. N Engl J Med 2013 · PMID 23692173 · DOI 10.1056/NEJMoa1215881
- Conservative management versus tonsillectomy in adults with recurrent acute tonsillitis in the UK (NATTINA): a multicentre, open-label, randomised controlled trial.. Wilson JA et al.. Lancet 2023 · PMID 37209706 · DOI 10.1016/S0140-6736(23)00519-6
- Laparoscopic cholecystectomy versus conservative management for adults with uncomplicated symptomatic gallstones: the C-GALL RCT.. Innes K et al.. Health Technol Assess 2024 · PMID 38943314 · DOI 10.3310/MNBY3104
- Postcholecystectomy diarrhoea rate and predictive factors: a systematic review of the literature.. Farrugia A et al.. BMJ Open 2022 · PMID 35177439 · DOI 10.1136/bmjopen-2020-046172
- Tonsillectomy or adenotonsillectomy versus non-surgical management for obstructive sleep-disordered breathing in children.. Venekamp RP et al.. Cochrane Database Syst Rev 2015 · PMID 26465274 · DOI 10.1002/14651858.CD011165.pub2
- Adenotonsillectomy for Snoring and Mild Sleep Apnea in Children: A Randomized Clinical Trial.. Redline S et al.. JAMA 2023 · PMID 38051326 · DOI 10.1001/jama.2023.22114
- Restrictive Strategy vs Usual Care for Cholecystectomy in Patients With Abdominal Pain and Gallstones: 5-Year Follow-Up of the SECURE Randomized Clinical Trial.. Comes DJ et al.. JAMA Surg 2024 · PMID 39167382 · DOI 10.1001/jamasurg.2024.3080