Clinical Review

Recent advances: General surgery

BMJ 1997; 315 doi: (Published 06 September 1997) Cite this as: BMJ 1997;315:586
  1. Carlos U Corvera, resident in general surgerya,
  2. Kimberly S Kirkwood, assistant professor of surgery (
  1. a University of California, San Francisco, Department of Surgery, Room U-372, 533 Parnassus Avenue, San Francisco, CA 94143-0790, USA
  1. Correspondence to: Dr Kirkwood


    In the modern era of managed care, surgeons have been pressured to re-evaluate the management of many common disease processes and seek cost effective measures while maintaining the quality of patient care. Recent advances in anaesthesia and minimal access surgery have facilitated the remarkable expansion of ambulatory or “short stay” surgery. As a result, patients with gall stones, gastro-oesophageal reflux, and peptic ulcers now have less morbidity and shorter hospital stays.


    The topics in this article were selected after we conducted an informal survey among the general surgeons at our institution. The consensus was that these topics, which have been influenced by managed care and advancing technology, represent the most recent and ongoing changes in general surgery. A Medline search for the topic ambulatory surgery used the keywords “ambulatory surgery,” “postoperative nausea and vomiting,” “propofol,” and “preemptive analgesia.” The keywords in the search for minimal access surgery were “laparoscopic common bile duct exploration,” “reflux disease,” “laparoscopic fundoplication,” “pancreatic pseudocyst,” and “perforated duodenal ulcer.” Additional keywords included “surgical treatment” and “laparoscopic and minimally invasive surgery.” Articles published since 1995 formed the basis of this review.

    Ambulatory surgery

    Ambulatory surgery was introduced in 1970, and its widespread acceptance was influenced by patients, surgeons, and cost considerations. Today, the growth of outpatient surgery is fuelled by a healthcare industry that demands high quality care at a lower cost. The current competitive healthcare environment has exerted tremendous pressure on surgeons and hospitals to increase the number and variety of outpatient procedures. It has been estimated that by the year 2000, about 75% of all surgical procedures in the United States will be ambulatory procedures.1 The recent successful expansion of outpatient surgery is predicated on advances in anaesthesia and a sweeping acceptance of minimally invasive techniques.

    The most common reasons for patients to require admission after …

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