Ann. Surg. * November 1975 LETTERS TO THE EDITOR We have operated upon 96 patients using truncal vag- requiring prolonged bougienage or further surgical prootomy and double pyloroplasty and have followed these cedures. During this period of time, it is apparent that Dr. patients from one month to 5 years with an average followup of three years. At the time of this writing we Woodward was using the treatment of hiatal hernia, herhave had one patient with probable recurrence of ulcers, niaplasty and advocating pyloroplasty rather than an 5 patients with minimal dumping syndrome and 4 patients, anti-reflux procedure.' Hence his results are not comparwith loose stools. Epigastric pain, bilious vomiting and able to those achieved by Harrington et al. now described anemia have not been encountered. Fortunately, our in the same issue of Annals of Surgery.2 His advocacy of concern about reflux gastritis has not materialized but we the Thal-Nissen patch graft should be considered in this will continue to watch for it. We are pleasantly surprised light. Incidentally, pyloroplasty as used by Woodward at our low recurrence rate and the minimal untoward then could increase the problem further with alkaline postoperative sequelae that has been encountered. reflux following destruction of the "Keeper of the Gate" James R. Hines, M.D. (Greek-pyloros). Professor of Surgery Lawrence Braslow, M.D. Northwestern University Medical School Arlington Medical Center Chief of Surgery, Wesley Pavilion Riverside, California 92503 Northwestern Memorial Hospital References Chicago, Illinois 60611

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References 1. Lynch, J.D., Jernigan, S.K., Trotta, P.H., and Clemes, B.E.: Incidence and Analysis of Failure with Vagotomy and HeinekeMikulicz Pyloroplasty. Surgery, 58:482, 1965. 2. Marckman, A., Baden, H. and Amdrup, E.: Selective Vagotomy Combined with Drainage Procedure in Treatment of Duodenal Ulcer: Selective Anterior and Total Posterior Vagotomy Compared with Bilateral Selective Vagotomy in One Hundred Sixteen Patients. Acta. Chir. Scand. (Suppl.), 396:41, 1969. 3. Smith, G.K. and Farris, J.M.: Reappraisal of the Long Term Effects of Selective Vagotmy. Am. J. Surg., 117:222, 1969. 4. Weinberg, J.A.: Vagotomy with Pyloroplasty in the Treatment of Duodenal Ulcer-Surgical Aspects. Am. J. Gastroenterol., 21:2%, 1954.

June 30, 1975 Dear Editor: In the issue of Annals of Surgery, May 1975, Volume 181, No. 5, Page 784, Woodward cites poor results following dilatation of the esophageal strictures encompassing an experience of 39 patients operated upon between 1953 and 1963. In this series he cites a high recurrence rate of both hiatal hernia and stricture, half the patients

1. Herington, J.L. Jr., M.D., Wright, R.S., Edwards, W.H., Sawyers, J.L.: Conservative Surgical Treatment of Reflux Esophagitis and Esophageal Stricture, Ann. Surg., 552-566, May 1975. 2. Eisenberg, M.M. and Woodward, E.R.: Hernioplasty, Vagotomy, and Drainage Procedure in the Management of Hiatal Hernia, Current Surgical Management III, W.B. Saunders Co., 1965: Pp. 227-233.

July 8, 1975 Dear Editor: Dr. David Tice has called to our attention an error in the text and in Table 2 of our paper published in the May 1975 issue of the Annals of Surgery. We reported a patency rate of 20%o (5 of 25) in 25 femoral popliteal bypasses using preserved saphenous vein homografts. This conclusion was based on a misinterpretation of the text and of Table 3 in his paper (Surgery 72: 260, 1972). The correct figure was a patency rate of 52% (13 of 25) of grafts followed for one year and 84% (7 of 8) followed for longer than one year. Jere W. Lord, M.D. New York. New York