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June 7, 1995

General Surgery

Author Affiliations

University of California—Davis, Oakland

JAMA. 1995;273(21):1682-1684. doi:10.1001/jama.1995.03520450052026

Ambulatory surgery, a landmark innovation driven by payment system changes, now accounts for approximately 50% of all surgery in the United States. It produces outcomes equivalent to those of inpatient surgery at considerable per-patient savings. This represents a dramatic shift in the locus of providing surgical care. In 1995, more than 3.5 million endoscopic procedures will be performed in ambulatory surgery units. Ambulatory surgery has achieved its quality-enhancing and cost-saving potential.1

In a prospective, randomized evaluation of parietal cell vagotomy and selective vagotomy with antrectomy for the treatment of duodenal ulcer complications, Jordan and Thornby2 found both procedures to be effective and safe operations when used appropriately. Selective vagotomy with antrectomy is preferable for patients with pyloric and prepyloric ulcers and those with pyloric obstruction. Meisner et al3 from Denmark studied the long-term recurrence rate after parietal cell vagotomy in duodenal, pyloric, and prepyloric ulcers. Of 350

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