Thoracoscopic truncal vagotomy was performed in three patients with recurrent ulcer after previous Billroth-II gastrectomy. The technique involved double-lumen endotracheal-endobronchial intubation and single-lung ventilation. No morbidity or mortality existed and the mean hospitalization was 7 days. To date, no recurrent ulceration has been detected in these patients. Thoracoscopic truncal vagotomy is considered to be a rapid, simple and safe approach and thus could play a preferential role in the management of patients with recurrent peptic ulcer after previous gastrectomy.