After an experience of seven years during which 620 vagotomies for various types of intractable peptic ulcer have been performed by the attending and resident staff of this clinic, we are persuaded that this is a relatively safe, efficient and practical method of surgical treatment and should replace subtotal gastrectomy as the initial, definitive, surgical treatment for duodenal, gastrojejunal and certain esophageal ulcers. It should regularly be combined with a posterior gastroenterostomy of small size to facilitate the emptying of the stomach and simplify postoperative management. Crile1 has employed pyloroplasty and Beattie2 partial pylorectomy instead of gastroenterostomy with success.
Surgical methods have been successful in the treatment of peptic ulcer, depending directly on the extent to which these procedures reduce the secretion of the pepsin and hydrochloric acid of the gastric juice. The most important of these methods in use at the present time are subtotal gastrectomy and