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Proximal gastric vagotomy. Gold or dross?

Proximal gastric vagotomy (PGV) is now popular among surgical gastroenterologists as an operation for the treatment of duodenal ulcer. Does PGV deserve this popularity, making it golden, or should it be considered dross, shunned by all? Conceptually, PGV should be the answer to our search for an operation with low morbidity and low mortality that removes the stigma of duodenal ulcer disease from our patients. There is no question that PGV can be performed with totally acceptable short- and long-term morbidity and operative mortality. The ever-increasing rate of ulcer recurrence, as reported in the world literature, concerns all of us. 1 When the problem of recurrent ulcer first became apparent, many were convinced that it was a matter of inadequate or imperfect operative technique, particularly when subsequent reports from the same authors showed a marked decrease in recurrence following a change in technical approach. The matter of technical expertise is