To the Editor.–Dr. Hoerr's comments are extremely interesting, but considerable difference of opinion exists regarding his philosophy of treating the complicated duodenal ulcer and that expressed in our paper. My remarks will reflect my own personal thoughts on the matter.
In regard to our present overall mortality with vagotomy-antrectomy, which is 1.6%, it was stressed that this mortality included elderly patients operated on as an emergency, particularly in the early part of the clinical study. The current mortality for elective operation is under 1%, which is almost identical to that following truncal vagotomy-pyloroplasty in Dr. Hoerr's hands.
Dr. Hoerr mentioned that perhaps it might be of interest to know our experience with truncal vagotomypyloroplasty, which was not alluded to in the paper. We have performed this operation on 264 patients, some of whom were high-risk, with an overall mortality of 5% and a recurrent ulcer rate of 17%.