Letter: Laparoscopic sterilization.

SiRjr-Despite the abundance of literature on duodenal ulcer very little information is available on the topographical progress of the ulcer after medical and surgical treatment. With the introduction of fibreoptic endoscopes the progress of the ulcer can be easily followed and recorded, particularly after highly selective vagotomy beca-use of the undisturbed anatomy. Since August 1973 in a consecutive series of 15 patients with duodenal ulcer I have record-ed the endoscopic appearances before highly selective vagotomy and at monthly intervals thereafter. At one month after surgery there was no significant change in the ulcer, though previously noticed periulerou congestion and oedema had 4disppeared. At two months three of the ulcers had completely healed and there was evidence of epithelization in the others. At three months only two of the ulcers remained unhealed: one of these had epithelized by the next examination but the other persisted at five months. All patients remained symptomless during this period. From this observation it transpires that, though symptomatic relief may be obtained immediately after surgery, it may take many months before the ulcer actually heals. Similar follow-up is being carried out durig eical -because from my experience it would seem that recommended courses of six weeks' treatment are too short for compklte healing of duodenal uloers.-I am, etc., M. SHAFIQ