Subtotal gastrectomy with bilateral truncal vagotomy is a good operation for peptic ulcer disease. Recurrence rates are low and diarrhea and dumping are usually tolerable. The development of gallstones following this procedure has become more problematic in that further operation becomes a real necessity. In 2 groups of patients having undergone a standardized subtotal gastrectomy, with and without truncal vagotomy, only 6% of the patients with resection alone had biliary calculi develop. This is consistent with the incidence of gallstone formation in the normal population. In the group undergoing resection with bilateral vagotomy, 21% had gallstones develop which were detected by ultrasonography or oral cholecystography and confirmed at operation. Cholelithiasis following truncal vagotomy is a long term complication which must be recognized, and, unless otherwise indicated, requires an additional surgical procedure. Only when results of long term follow-up studies verify the therapeutic effectiveness of operations such as highly selective or parietal cell vagotomy without drainage, will a more physiologically sound operation be possible.