In Reply.–I must apologize to Dr William O. Barnett for failure to cite his description of Roux-en-Y duodenojejunostomy for duodenal stump closure as kindly point out by Dr Herrington.
While agreeing unreservedly about everything that was said in both Dr Nardi's editorial comment and Dr Herrington's letter, I nevertheless would like to point out that both rather missed the point of the article. Undoubtedly, the best way to deal with a difficult situation is to avoid it, but in the meantime what should the inexperienced and the unwary do when he discovers that it is too late to follow the counsel of perfection? Dr Herrington has emphasized the superiority of Billroth I reconstruction under such circumstance, a principle shared by both forms of duodenojejunostomy. We believe though, for an ulcer occurring at the level of the ampulla, some tension may be unavoidable in a Billroth I anastomosis even in