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In duodenal ulcer with complete pyloric stenosis selective proximal vagotomy in connection with either pyloric dilatation or duodenoplasty is generally indicated. Pyloroplasty may still be considered as an acceptable alternative drainage procedure. In high risk patients with pyloric stenosis, especially in the very old, truncular vagotomy with an adequate drainage is the operation of choice because of its low operative trauma. Penetrating ulcers are treated by selective proximal vagotomy only. Postoperative pyloric stenosis occurs rarely and should be managed by secondary pyloroplasty or pyloric dilatation.
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