The majority of our patients with bleeding duodenal ulcer responded to endoscopic injection treatment. However, in six patients admitted during a 21/2-year period, we were forced to do emergency surgery to control the hemorrhage (three with failed injection and persisting exsanguination from a brisk bleeder and three rebled soon after apparent initial hemostasis). We performed an innovative procedure: pyloroplasty was done after oversewing the arterial bleeder in the duodenum through a small transverse wound in the right upper quadrant. The wound was then closed around a 10-mm trocar sheath. With the addition of three more ports, a truncal vagotomy was completed laparoscopically. Recovery was rapid and uneventful in all six cases; postoperative pain was minimal. The mean operative time was 85 minutes. We believe that, in a selected group of patients, laparoscopic vagotomy and open pyloroplasty through an essentially extended port wound (as described in detail) is an expedient and effective procedure in the emergency setting.