{"id":404,"date":"2025-06-30T06:27:31","date_gmt":"2025-06-30T06:27:31","guid":{"rendered":"https:\/\/www.drharshvardhanpuri.com\/blog\/?p=404"},"modified":"2025-06-30T06:27:31","modified_gmt":"2025-06-30T06:27:31","slug":"collapsed-lung-surgery-treatment-options","status":"publish","type":"post","link":"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/","title":{"rendered":"Does a Collapsed Lung Require Surgery?"},"content":{"rendered":"<p>A collapsed lung is a serious medical condition. It can happen suddenly and cause sharp chest pain and difficulty in breathing. If you or someone close to you is diagnosed with a <a href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/what-is-pneumothorax-collapsed-lung-causes-types-treatment\/\">collapsed lung<\/a>, one of the first questions that comes to mind is, \u201cDoes this require surgery?\u201d<\/p>\n<p>The answer is: sometimes yes, sometimes no. It depends on how serious the collapse is, what caused it, and how your body responds to treatment.<\/p>\n<p>In this blog, we\u2019ll break down everything you need to know about a collapsed lung, when surgery is needed, and how doctors decide the best treatment plan.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Is_a_Collapsed_Lung\"><\/span>What Is a Collapsed Lung?<span class=\"ez-toc-section-end\"><\/span><\/h2><div id=\"ez-toc-container\" class=\"ez-toc-v2_0_79_2 counter-hierarchy ez-toc-counter ez-toc-grey ez-toc-container-direction\">\n<div class=\"ez-toc-title-container\">\n<p class=\"ez-toc-title\" style=\"cursor:inherit\">Table of Contents<\/p>\n<span class=\"ez-toc-title-toggle\"><a href=\"#\" class=\"ez-toc-pull-right ez-toc-btn ez-toc-btn-xs ez-toc-btn-default ez-toc-toggle\" aria-label=\"Toggle Table of Content\"><span class=\"ez-toc-js-icon-con\"><span class=\"\"><span class=\"eztoc-hide\" style=\"display:none;\">Toggle<\/span><span class=\"ez-toc-icon-toggle-span\"><svg style=\"fill: #999;color:#999\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" class=\"list-377408\" width=\"20px\" height=\"20px\" viewBox=\"0 0 24 24\" fill=\"none\"><path d=\"M6 6H4v2h2V6zm14 0H8v2h12V6zM4 11h2v2H4v-2zm16 0H8v2h12v-2zM4 16h2v2H4v-2zm16 0H8v2h12v-2z\" fill=\"currentColor\"><\/path><\/svg><svg style=\"fill: #999;color:#999\" class=\"arrow-unsorted-368013\" xmlns=\"http:\/\/www.w3.org\/2000\/svg\" width=\"10px\" height=\"10px\" viewBox=\"0 0 24 24\" version=\"1.2\" baseProfile=\"tiny\"><path d=\"M18.2 9.3l-6.2-6.3-6.2 6.3c-.2.2-.3.4-.3.7s.1.5.3.7c.2.2.4.3.7.3h11c.3 0 .5-.1.7-.3.2-.2.3-.5.3-.7s-.1-.5-.3-.7zM5.8 14.7l6.2 6.3 6.2-6.3c.2-.2.3-.5.3-.7s-.1-.5-.3-.7c-.2-.2-.4-.3-.7-.3h-11c-.3 0-.5.1-.7.3-.2.2-.3.5-.3.7s.1.5.3.7z\"\/><\/svg><\/span><\/span><\/span><\/a><\/span><\/div>\n<nav><ul class='ez-toc-list ez-toc-list-level-1 ' ><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-1\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#What_Is_a_Collapsed_Lung\" >What Is a Collapsed Lung?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-2\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Types_of_Collapsed_Lung\" >Types of Collapsed Lung<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-3\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#1_Spontaneous_Pneumothorax\" >1. Spontaneous Pneumothorax<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-4\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#2_Traumatic_Pneumothorax\" >2. Traumatic Pneumothorax<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-5\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#3_Tension_Pneumothorax\" >3. Tension Pneumothorax<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-6\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Symptoms_of_a_Collapsed_Lung\" >Symptoms of a Collapsed Lung<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-7\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#How_Is_a_Collapsed_Lung_Diagnosed\" >How Is a Collapsed Lung Diagnosed?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-8\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Does_Every_Collapsed_Lung_Need_Surgery\" >Does Every Collapsed Lung Need Surgery?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-9\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Non-Surgical_Treatment_Options\" >Non-Surgical Treatment Options<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-10\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#1_Observation_Watchful_Waiting\" >1. Observation (Watchful Waiting)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-11\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#2_Needle_Aspiration\" >2. Needle Aspiration<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-12\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#3_Chest_Tube_Insertion_Tube_Thoracostomy\" >3. Chest Tube Insertion (Tube Thoracostomy)<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-13\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#When_Is_Surgery_Required_for_a_Collapsed_Lung\" >When Is Surgery Required for a Collapsed Lung?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-14\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#1_Recurrent_Collapsed_Lung\" >1. Recurrent Collapsed Lung<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-15\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#2_Large_or_Non-Healing_Pneumothorax\" >2. Large or Non-Healing Pneumothorax<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-16\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#3_Tension_Pneumothorax-2\" >3. Tension Pneumothorax<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-17\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#4_Underlying_Lung_Disease\" >4. Underlying Lung Disease<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-18\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#What_Kind_of_Surgery_Is_Done\" >What Kind of Surgery Is Done?<\/a><ul class='ez-toc-list-level-3' ><li class='ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-19\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Video-Assisted_Thoracoscopic_Surgery_VATS\" >Video-Assisted Thoracoscopic Surgery (VATS)<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-3'><a class=\"ez-toc-link ez-toc-heading-20\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Pleurodesis\" >Pleurodesis<\/a><\/li><\/ul><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-21\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Recovery_After_Surgery\" >Recovery After Surgery<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-22\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Can_You_Prevent_a_Collapsed_Lung\" >Can You Prevent a Collapsed Lung?<\/a><\/li><li class='ez-toc-page-1 ez-toc-heading-level-2'><a class=\"ez-toc-link ez-toc-heading-23\" href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/collapsed-lung-surgery-treatment-options\/#Conclusion\" >Conclusion<\/a><\/li><\/ul><\/nav><\/div>\n\n<p>A <a href=\"https:\/\/www.drharshvardhanpuri.com\/pneumothorax-treatment-in-delhi.html\">collapsed lung is also known as a pneumothorax<\/a>. This happens when air leaks into the space between the lung and the chest wall. This air puts pressure on the lung and causes it to collapse.<\/p>\n<p>Your lungs need room to expand when you breathe. When air fills the space outside the lung, the lung can no longer expand properly, and this leads to breathing problems.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Types_of_Collapsed_Lung\"><\/span>Types of Collapsed Lung<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>There are different <a href=\"https:\/\/www.drharshvardhanpuri.com\/pneumothorax-treatment-in-gurgaon.html\">types of pneumothorax<\/a>. Understanding which type you have helps doctors decide whether surgery is needed.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"1_Spontaneous_Pneumothorax\"><\/span>1. Spontaneous Pneumothorax<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>This can happen without any clear reason. It\u2019s more common in:<\/p>\n<ul>\n<li>Tall, thin young people<\/li>\n<li>Smokers<\/li>\n<li>People with lung diseases<\/li>\n<\/ul>\n<p><strong>There are two types<\/strong>Primary spontaneous pneumothorax (occurs in healthy people)<\/p>\n<ul>\n<li>Secondary spontaneous pneumothorax (happens in people with existing lung problems like COPD or asthma)<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"2_Traumatic_Pneumothorax\"><\/span>2. Traumatic Pneumothorax<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>This is caused by injury. It could be from:<\/p>\n<ul>\n<li>A car accident<\/li>\n<li>A fall<\/li>\n<li>A stab or gunshot wound<\/li>\n<li>Broken ribs<\/li>\n<\/ul>\n<h3><span class=\"ez-toc-section\" id=\"3_Tension_Pneumothorax\"><\/span>3. Tension Pneumothorax<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>This is the most dangerous type. It happens when air enters the chest cavity and cannot escape. The pressure keeps building, pushing the lung and even the heart. This is a medical emergency and often requires immediate surgery.<\/p>\n<p>Also read: <a href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/pneumothorax-treatment-recovery-how-long-before-symptoms-go-away\/\">Pneumothorax Treatment Recovery: How Long Before Symptoms Go Away?<\/a><\/p>\n<h2><span class=\"ez-toc-section\" id=\"Symptoms_of_a_Collapsed_Lung\"><\/span>Symptoms of a Collapsed Lung<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The symptoms can vary based on how much of the lung has collapsed. Common signs include:<\/p>\n<ul>\n<li>Sudden sharp chest pain<\/li>\n<li>Shortness of breath<\/li>\n<li>Fast breathing<\/li>\n<li>Rapid heartbeat<\/li>\n<li>Feeling of tightness in the chest<\/li>\n<li>Coughing<\/li>\n<li>Fatigue or dizziness<\/li>\n<\/ul>\n<p>If the lung collapse is large or causes tension, the symptoms are more severe, and emergency care is needed.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"How_Is_a_Collapsed_Lung_Diagnosed\"><\/span>How Is a Collapsed Lung Diagnosed?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Doctors usually begin with a physical exam and then do tests like:<\/p>\n<ul>\n<li>Chest X-ray: Shows how much the lung has collapsed<\/li>\n<li>CT Scan: Gives more detailed images<\/li>\n<li>Ultrasound: Sometimes used in emergencies<\/li>\n<\/ul>\n<p>Your doctor will also ask about your medical history, smoking habits, injuries, or past lung problems.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Does_Every_Collapsed_Lung_Need_Surgery\"><\/span>Does Every Collapsed Lung Need Surgery?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Not always. The treatment depends on:<\/p>\n<ul>\n<li>The size of the collapse<\/li>\n<li>The cause of the collapse<\/li>\n<li>Your overall health<\/li>\n<li>Whether it\u2019s the first time or a repeat occurrence<\/li>\n<\/ul>\n<p>Let\u2019s look at the different treatment options.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Non-Surgical_Treatment_Options\"><\/span>Non-Surgical Treatment Options<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<h3><span class=\"ez-toc-section\" id=\"1_Observation_Watchful_Waiting\"><\/span>1. Observation (Watchful Waiting)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>For a small pneumothorax without major symptoms, doctors may simply monitor you. Your body can sometimes reabsorb the air on its own in a few days.<\/p>\n<p>You might be:<\/p>\n<ul>\n<li>Given oxygen to help your body absorb the air faster<\/li>\n<li>Asked to rest and avoid physical activity<\/li>\n<li>Checked regularly with X-rays to see if the lung is healing<\/li>\n<\/ul>\n<p>This is usually the approach for a first-time, small primary spontaneous pneumothorax.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"2_Needle_Aspiration\"><\/span>2. Needle Aspiration<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>If there\u2019s more air trapped, your doctor may insert a needle into your chest to remove the air. This helps the lung re-expand. This procedure is done under local anesthesia and usually doesn&#8217;t take long.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"3_Chest_Tube_Insertion_Tube_Thoracostomy\"><\/span>3. Chest Tube Insertion (Tube Thoracostomy)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>In larger pneumothorax cases, a chest tube is inserted through your side into the pleural space. This tube allows the trapped air to escape and gives your lung room to expand again. You may need to stay in the hospital for a few days while this tube does its job.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"When_Is_Surgery_Required_for_a_Collapsed_Lung\"><\/span>When Is Surgery Required for a Collapsed Lung?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>There are situations where surgery becomes necessary. Let\u2019s look at some of the most common ones:<\/p>\n<h3><span class=\"ez-toc-section\" id=\"1_Recurrent_Collapsed_Lung\"><\/span>1. Recurrent Collapsed Lung<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>If your lung collapses more than once, doctors usually recommend surgery to prevent it from happening again.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"2_Large_or_Non-Healing_Pneumothorax\"><\/span>2. Large or Non-Healing Pneumothorax<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>If a chest tube or needle does not fix the issue within a few days, surgery may be needed to seal the leak or remove damaged parts of the lung.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"3_Tension_Pneumothorax-2\"><\/span>3. Tension Pneumothorax<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>This is an emergency. It often requires immediate surgical drainage or repair to save your life.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"4_Underlying_Lung_Disease\"><\/span>4. Underlying Lung Disease<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>If you have a collapsed lung due to chronic lung disease, surgery might help reduce future risks and improve lung function.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"What_Kind_of_Surgery_Is_Done\"><\/span>What Kind of Surgery Is Done?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>The most common surgery for a collapsed lung is:<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Video-Assisted_Thoracoscopic_Surgery_VATS\"><\/span>Video-Assisted Thoracoscopic Surgery (VATS)<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<ul>\n<li>A minimally invasive procedure<\/li>\n<li>Small cuts are made, and a tiny camera is used<\/li>\n<li>Surgeons can find the air leak, remove damaged lung tissue (called blebs), and close the leak<\/li>\n<\/ul>\n<p>This surgery is safer and involves a quicker recovery than traditional open chest surgery.<\/p>\n<h3><span class=\"ez-toc-section\" id=\"Pleurodesis\"><\/span>Pleurodesis<span class=\"ez-toc-section-end\"><\/span><\/h3>\n<p>In some cases, the surgeon will do a pleurodesis. This is a procedure where the lung is attached to the chest wall using medicine or by scratching the pleural lining. It helps prevent future lung collapses.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Recovery_After_Surgery\"><\/span>Recovery After Surgery<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Most people stay in the hospital for a few days after surgery. Full recovery takes a few weeks. You\u2019ll need to:<\/p>\n<ul>\n<li>Avoid heavy lifting or strenuous activity for a while<\/li>\n<li>Stop smoking if you haven\u2019t already<\/li>\n<li>Follow up with your doctor for imaging and checkups<\/li>\n<\/ul>\n<p>Complications from surgery are rare but may include infection, pain, or a small chance of the lung collapsing again.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Can_You_Prevent_a_Collapsed_Lung\"><\/span>Can You Prevent a Collapsed Lung?<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>Not always, but you can reduce your risk by:<\/p>\n<ul>\n<li>Quitting smoking<\/li>\n<li>Avoiding activities that cause sudden changes in air pressure (e.g., scuba diving, flying in unpressurized cabins)<\/li>\n<li>Treating lung diseases early<\/li>\n<li>Using protective gear if your job involves physical risk<\/li>\n<\/ul>\n<p>If you&#8217;ve had a collapsed lung before, discuss with your doctor what activities to avoid in the future.<\/p>\n<h2><span class=\"ez-toc-section\" id=\"Conclusion\"><\/span>Conclusion<span class=\"ez-toc-section-end\"><\/span><\/h2>\n<p>So, does a <a href=\"https:\/\/www.drharshvardhanpuri.com\/blog\/pneumothorax-surgery-cost-in-india\/\">collapsed lung require surgery?<\/a> The answer depends on the size, cause, and whether it happens more than once. Many people recover without surgery, especially if it\u2019s a small and first-time event. But in serious or repeat cases, surgery can be life-saving and prevent future problems.<\/p>\n<p>If you experience symptoms of a collapsed lung\u2014like sudden chest pain or trouble breathing, seek medical help immediately. <a href=\"https:\/\/www.drharshvardhanpuri.com\">Dr Harsh Vardan Puri<\/a> can assess your condition and decide the best course of treatment.<\/p>\n<p>With proper care and the right medical advice, most people recover fully from a collapsed lung and return to normal life.<\/p>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>A collapsed lung is a serious medical condition. It can happen suddenly and cause sharp chest pain and difficulty in breathing. If you or someone close to you is diagnosed with a collapsed lung, one of the first questions that comes to mind is, \u201cDoes this require surgery?\u201d The answer is: sometimes yes, sometimes no. [&hellip;]<\/p>\n","protected":false},"author":1,"featured_media":405,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[67],"tags":[],"class_list":["post-404","post","type-post","status-publish","format-standard","has-post-thumbnail","hentry","category-pneumothorax"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v26.5 - https:\/\/yoast.com\/wordpress\/plugins\/seo\/ -->\n<title>Does a Collapsed Lung Need Surgery? Causes &amp; Treatment Options<\/title>\n<meta name=\"description\" content=\"Wondering if a collapsed lung requires surgery? 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