THE WIDE range of opinion regarding the surgical treatment of peptic ulcer continues to challenge the surgeon's acumen in selecting an operation for the individual patient. Many procedures have been shown to permit recurrent ulceration, and some to lead to complications as serious as the original disease. It also becomes obvious to the surgeon early in his experience that ulcer patients do not fall into a single category, and that the same procedure cannot be recommended for all. The only rule that is generally applicable is that vagotomy should be included as a fundamental step in all operations for peptic ulcer.
Searching for factors significant to choice among the available techniques, we have studied retrospectively 527 of the 664 patients on whom operation for peptic ulcer disease was performed during the ten years 1955-1964 by various members of the surgical staff of the Kaiser Foundation Hospital, Los Angeles. In considering