Exceptional contributions by several physiologists and surgeons in the first half of the 20th century greatly added to our knowledge of gastric acid secretion.6 Ivan Pavlov, PhD, described the cephalic phase of acid secretion in the dog model and received the Nobel prize for his contributions. In France, Mathieu Jaboulay, MD, performed the first human vagotomy. Andre Latarjet, MD, detailed the lesser curve vagi, performed the first therapeutic vagotomy for treatment of an active peptic ulcer, and noted the deleterious effects of vagotomy on gastric emptying. William Bayliss, PhD, and Ernest Starling, PhD, elucidated secretin and its contribution to the gastric phase of acid secretion. Lester Dragstedt, MD, PhD, reported on the importance of pyloroplasty as an adjunct to vagotomy to prevent gastric stasis. Further, he noted that the release of gastrin was due in part to an elevated gastric pH. He proposed that vagotomy combined with antrectomy was a superior operation for peptic ulcer disease owing to its eradication of the cephalic and gastric influences on acid secretion. In separate observations in the 1950s, Farmer and Smithwick7 at Boston University, Boston, Mass, and Edwards and Herrington8 at Vanderbilt University, Nashville, Tenn, reported the durability of vagotomy and antrectomy in the treatment of complicated peptic ulcer disease with long-term recurrence rates of less than 1%. Thus, the second half of the 20th century was noteworthy for several operations based on sound physiologic principles that resulted in effective surgical treatment of complicated peptic ulcer disease. Vagotomy and pyloroplasty, highly selective vagotomy, and vagotomy combined with antrectomy are most commonly used. While complications such as dumping, bile reflux, and gastric atony have been described, long-term morbidity has remained very low. These operations have proven to be safe and effective with very low ulcer recurrence rates.