Operations for Duodenal Ulcer

To the Editor.–The excellent paper by Herrington et al (Arch Surg 106:469, 1973) presents a persuasive case for vagotomy-antrectomy as the preferred procedure for chronic duodenal ulcer requiring operation. The operative mortality has progressively dropped to 1.6%. The rate of proved recurrent ulcer is an extremely low 0.6% and clinically satisfactory results are 94%. The case is apparently proved. The authors do concede a place for vagotomy-drainage in poor-risk patients or when a gastric resection may be unduly hazardous.

The authors are not very charitable, however, when they say, "It is difficult, however, to accept the complacency of the proponents of truncal vagotomy-pyloroplasty who willingly accept a 10% to 15% rate of recurrent ulceration and the subsequent need for a second operation of 5% to 10% of patients with the associated increased morbidity and mortality." It is unfortunate that no strong proponent of conservative operations was represented among the