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

Step 1: Know what each surgery does to the pylorus.
Truncal vagotomy cuts both vagal trunks near the esophagus. This denervates the whole stomach, so the pylorus stops relaxing on its own and a drainage step (pyloroplasty) has to be added to let food leave the stomach.
Truncal vagotomy with antrectomy removes the acid producing vagal supply and the gastrin producing antrum together, giving the lowest ulcer recurrence but destroying the pylorus completely.
Gastrojejunostomy joins the stomach straight to the jejunum and bypasses the pylorus without removing it, so food and bile move through with no valve to slow them down.

Step 2: Connect pyloric loss to the symptoms in the question.
Bilious vomiting happens when bile refluxes back into the stomach because the pylorus no longer acts as a one way valve.
Dumping happens when a hyperosmolar meal empties too fast into the small bowel, since there is no pylorus left to hold it back and release it slowly.
Diarrhea follows the same rapid transit, plus loss of vagal control over small bowel motility.
All three problems are worst when the pylorus is bypassed or removed, as in pyloroplasty, antrectomy, or gastrojejunostomy.

Step 3: See why highly selective vagotomy avoids this.
HSV only cuts the vagal branches that go to the acid making parietal cells in the upper stomach (the fundus and body). It leaves the nerve of Latarjet, the antrum, and the pylorus fully intact and working.
Because the pylorus still opens and closes normally, gastric emptying stays close to normal, and no drainage procedure is needed.

Step 4: Rule out the other options.
Truncal vagotomy with pyloroplasty forces the pylorus open, so bile reflux and rapid emptying are common.
Truncal vagotomy with antrectomy removes the pylorus outright, giving the highest rates of dumping and diarrhea among the standard operations.
Gastrojejunostomy alone leaves a wide open channel next to a bypassed pylorus, so bile still washes into the stomach freely.

Step 5: Final answer.
Since HSV is the only option that keeps the pylorus working, it causes the least bilious vomiting, dumping, and diarrhea. \[ \boxed{\text{Highly selective vagotomy}} \]