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.
PETERSON JA. The Appropriate Ulcer Cure. Arch Surg. 1984;119(9):1099–1100. doi:10.1001/archsurg.1984.01390210089022
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