Proximal gastric vagotomy in the emergency treatment of bleeding duodenal ulcer. Proximal gastric vagotomy for bleeding duodenal ulcer was performed in 52 low-risk patients between 1973 and 1986. Duodenotomy without violation of the pylorus was done in all patients to allow inspection and control of the bleeding site. The median duration of operation was 3 hours and 20 minutes, although 25% of the procedures required 4 or more hours. There was no postoperative mortality and no early reoperations. Among the six patients with postoperative complications, one rebled from the ulcer and two developed prolonged gastric atony. At the time of follow-up (median, 2.9 years), 48 of the patients were alive and 4 had died of non-ulcer causes. No patient had significant postvagotomy sequelae. Ulcer recurrence was documented in six patients, and three required reoperation. Proximal gastric vagotomy is a safe, effective therapy for bleeding duodenal ulcer. Because of the length of the operation, it should be restricted to low-risk patients who are hemodynamically stable at the time of operation. 