Question

Which gastric surgery results in the least degree of bilious vomiting, dumping, and diarrhea?

• A. Truncal vagotomy and pyloroplasty
• B. Truncal vagotomy and antrectomy
• C. Highly selective vagotomy (HSV)
• D. Gastrojejunostomy

Hint:

Look for the operation that leaves the pylorus untouched and working.

Answer 1

The Correct Option is C

This question is about picking the ulcer surgery that keeps stomach emptying closest to normal. The side effects named, bile in vomit, dumping, and loose stools, all come from one shared cause: loss of the pylorus as a working valve.

1. Truncal vagotomy and pyloroplasty: pyloroplasty means the surgeon cuts open the pylorus and sews it wider, so it can never close properly again. Bile flows back and food dumps fast.
2. Truncal vagotomy and antrectomy: this removes the antrum and pylorus together. It cures ulcers well but leaves nothing to slow gastric emptying, so dumping and diarrhea are common.
3. Highly selective vagotomy: this only cuts the nerve branches feeding the acid making part of the stomach. The antrum, pylorus, and nerve of Latarjet are left alone, so the stomach still empties in a controlled, normal way.
4. Gastrojejunostomy: a new opening is made straight from stomach to jejunum. The old pylorus is left in place but bypassed, so bile and food can still rush through the new channel.

Only highly selective vagotomy leaves the pyloric pump working the way nature built it, so it is the operation with the lowest rate of bilious vomiting, dumping, and diarrhea.

Let's summarize:

• Bile reflux, dumping, and diarrhea are pylorus loss problems, not vagotomy problems by themselves.
• HSV is the only listed procedure that spares the pylorus completely.

So the correct answer is highly selective vagotomy.