Recent data show that around 20% of duodenal ulcers present with a recurrence after eradication of Helicobacter pylori. Moreover, around 6% of duodenal ulcer patients are H. pylori negative. In those situations and in complicated peptic ulcer disease, laparoscopic highly selective vagotomy is a reasonable option. It can be performed on an outpatient basis and allows the patient to return to full activity within one week.