Vagotomy for the treatment of duodenal ulcer disease was first done by Dragsdet and Owens via a thoracic approach. Following their lead, essentially all operations for duodenal ulcer or marginal ulcer include some form of vagotomy. Ninety percent of marginal ulcers occurring after a previous drainage procedure or peptic ulcers occurring after bariatric surgery heal following vagotomy. The thoracoscopic approach is straightforward, causes little morbidity and allows discharge after one day.