GASTRIC ulcer at or above the reentrant angle has always posed a difficult technical problem to the surgeon. The many operative procedures described for treatment of these lesions may be divided into two groups: those that leave the ulcer in situ and those designed to remove the ulcer.
For the first group gastroenterostomy and pyloroplasty have been tried and found unsatisfactory for the reason that they are physiologically poor operations which do not attack and remove the acid-bearing and hormone-secreting areas of the stomach. All writers on vagotomy caution against the dangers of supradiaphragmatic vagotomy for gastric ulcer. According to Colp, infradiaphragmatic vagotomy for ulcer with edema and induration reaching the esophagus is a technically hazardous procedure. He advocated a subtotal palliative gastrectomy that leaves the ulcer in situ.1 Although physiologically this is a sound procedure since it produces achlorhydria and healing of the ulcer, it is open to