""When is better to do a surgery instead of a flush/cleanse?""
The straight answer to that is Never!
Unless your into helping a sergeon with his or her big morgage.
Go to the Ask Dr Sutter forum.
Its discussed in length about "not getting anything stuck during a flush".
The short story to that is to drink a quart of apple juice for three days prior to a flush and adding some ultrafos to the juice.
The malic acid in the apple juice softens the stones and the ultrafos also does the same.
If you add that to your flush along with the Epsom Salt you will be in the optimum position for a 100% stuck free flush and tell the physicion - good luck with the morgage.