Surgery for gout is uncommon, but it does occur. Sometimes buildups and tophi need to be removed. Those who have suffered with gout and who have ready access to drugs such as Allopurinol and Colchicine/Colcrys, as well as control of their diet, can usually control gout. Given his limited access to timely meds, and his inability to control his diet, Theo may be in a different place medically than the majority of gout sufferers. Let his medical team make the call on proper treatment.