To the Editor.—I wish to commend Dr Nyhus for his excellent commentary on the future of the proximal gastric vagotomy.1 However, woven through his discussion, as in all surgical literature, is a basic philosophy that increases rather than alleviates the frustration encountered in dealing with peptic ulcer disease, which is that the search is on for one comprehensive, one-time operation for ulcer disease, regardless of circumstances. Yet all this study is of a disease that has consistently proved itself to be more complex, as time and technology have helped us discover. Originally, the ulcer was thought to be simply a local phenomenon and was only excised. As more was learned about the physiology involved, more intricate and generally successful procedures were devised. Yet recurrence remains a problem, so much so that it would seem prudent to stop and ask whether the basic assumptions are universally valid.