GASTROENTEROSTOMY in the treatment of intractable duodenal ulcer has had a varied career. Its initial popularity was gradually dissipated when the true incidence of its complications was demonstrated and subtotal gastric resection became the operation of choice for the majority of these patients. The pendulum now swings back with gastroenterostomy being advocated as an adjunct to vagotomy in those cases in which some degree of pyloric obstruction exists preoperatively (Dragstedt1). It is to be expected that the incidence of gastrojejunal ulcer will prove to be negligible due to the low levels of gastric acidity produced by the associated vagotomy. Whether difficulties in motility and gastric emptying will lower the efficiency of this combined procedure only follow-up studies can determine.
There is, however, a type of patient in whom gastroenterostomy in itself has always yielded good results, in whom vagotomy is not required and in whom subtotal gastric resection is