The results in a consecutive series of 248 patients with bilateral vagotomy and gastrojejunostomy for chronic duodenal ulcer after a minimum follow-up period of ten years are presented. 1. Results are assessed as 'excellent' in 66.1%., 'good' in 16.4%., 'improved' in 8.2%., and 'failed' in 9.3%. 2. Stomal ulceration is found in 3.6%, and recurrent ulceration in a further 1.5%. 3. The side effects of the operation are: poor appetite, flatulence, bilious vomiting, diarrhoea, vasomotor symptoms, weight loss, anaemia and pulmonary tuberculosis. With the exception of bilious vomiting and diarrhoea, the incidence of these side effects is low. Although the incidence of bilious vomiting and diarrhoea is high, most cases are mild and are not troublesome to the patient. 4. The severity of the duodenal ulcer does not affect the result of the operation or the incidence of side effects. 5. The non-secretor state predisposes to duodenal ulceration. The association of blood group O with duodenal ulceration, noted by other workers, is not confirmed in this series. 6. The blood group and secretor status do not affect the severity of the ulcer or the outcome of treatment. 7. The blood group and secretor status do not influence the incidence of side effects with the exception of diarrhoea. Diarrhoea occurs with greater frequency in secretors when compared with non-secretors. 8. The age at operation does not affect the result of the operation. 9. The younger the patient, the more likely he is to develop side effects. 10. The longer the history of duodenal ulceration, the better the result of operation. 11. The shorter the history, the more likely is the patient to develop post-operative side effects. The author concludes that bilateral vagotomy and gastrojejunostomy is the operation of choice in patients with chronic duodenal ulcer and should be adopted as the routine surgical procedure in the first instance
