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Of the various postgastric operation syndromes early dumping, late dumping, bilious vomiting, and diarrhoea were all less frequent, but not significantly so, after vagotomy and pyloroplasty than after vagotomy and gastroenterostomy.Recurrent ulceration was commoner after vagotomy and pyloroplasty than after all the other operations, the incidence of proved and suspected recurrent ulcers being respectively 6-7 and 7 3% after vagotomy and pyloroplasty, but only 2 5 and 5-9% after vagotomy and gastroenterostomy, 0 and 5-2% after vagotomy and antrectomy, and 0 9 and 3-7% after subtotal gastrectomy. The differences between vagotomy and pyloroplasty and vagotomy and antrectomy or subtotal gastrectomy are statistically significant, but those between vagotomy and pyloroplasty and vagotomy and gastroenterostomy are not.

A survey was undertaken of 558 men with duodenal ulcer who had been treated ten to 16 years previously by truncal vagotomy and drainage, truncal vagotomy and antrectomy and subtotal gastrectomy. Of the 558, 65 had died and 111, presumed living, could not be traced, leaving 382 available for assessment. Between 75 and 85% of the traced patients were considered to have an excellent or very good result, which is a slight improvement on the previously published results in this same group of patients at five to eight years follow-up. Some of the side effects of operation had diminished slightly in frequency and there had been no significant increase in the incidence of recurrent ulceration since the previous survey. Anemia was an uncommon finding. As between the various forms of operation, truncal vagotomy and antrectomy and subtotal gastrectomy demonstrated significantly better protection against proven recurrent ulcer than did truncal vagotomy and pyloroplasty (p less than 0.05). Compared with truncal vagotomy and gastroenterostomy, however, the results of both resection operations, though better, did not achieve statistical significance at p - 0.5 level (p less than 0.1). In regard to Visick gradings the resection procedures had better scores, but the differences were not significant at the p - 0.05 level, except for vagotomy and antractomy as compared with vagotomy and pyloroplasty. But it is stressed that in formulating a policy of surgical therapy for duodenal ulcer the greater inherent immediate risks of resection operations need to be borne in mind.

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Duodenal Ulcer-Goligher et al. MEDICAL JOURNAL 787 annually, and this paper describes the latest results obtained on them at follow-up five to eight years after operation:(1) Most " postgastric operation syndromes " occurred with roughly equal frequency after all three operations, but early dumping was marginally more common and severe after subtotal gastrectomy; however, it very seldom assujned crippling proportions. Diarrhoea was certainly more frequent after the two vagotomy operations than after gastrectomy, but most of it was very slight and occurred episodically, so that it was only rarely a source of disability.(2) A comparison between the postoperative weight of patients and the optimal weight of individuals of the same age and height, as calculated from life assurance tables, showed a distinctly greater reduction of weight after gastrectomy and vagotomy and antrectomy than after vagotomy and gastroenterostomy.(3) Recurrent ulceration was diagnosed in 7 to 10% of patients after vagotomy and gastroenterostomy and in 2 to 5 or 6% of patients after vagotomy and antrectomy or subtotal gastrectomy.(4) Overall assessment of the quality of the results (Visick grading) after the three operations showed vagotomy and antrectomy and subtotal gastrectomy to be slightly superior to vagotomy and gastroenterostomy, but the difference was statistically insignificant. The results of all operations tended to deteriorate gradually with the passage of time.The results in female patients were analysed only in those who had had vagotomy and gastroenterostomy. A comparison of the outcome of this operation in women and men, revealed that the results were distinctly poorer in the former, with I higher incidence of most postgastric operation symptoms and of recurrent ulceration than in men.We would like to express our thanks to the following for their assistance in the conduct of this study: Mrs. R. Nicolson, Mrs. M. A. Pybus, and Miss Lyn Alexander for secretarial services; Mrs. Dent for help in tracing patients; and the Medical