Following a highly selective vagotomy (proximal gastric vagotomy/HSV), what is the physiological mechanism by which basal acid output is reduced without affecting antral motility and pyloric function?

• A Denervation of the antrum and pylorus causes reduced gastrin release
• B Selective denervation of the acid-secreting fundus and corpus while preserving the 'nerve of Latarjet' to the antrum and pylorus ✓
• C Complete vagal trunk division causing reduced acetylcholine-mediated parietal cell stimulation
• D Division of the hepatic branch of the vagus, eliminating cephalic phase of secretion

Explanation

Highly selective (proximal gastric) vagotomy denervates only the fundus and corpus of the stomach (which contain the acid-secreting parietal cells) by dividing the vagal branches to these regions while meticulously preserving the terminal branches of the 'nerve of Latarjet' (the distal hepatic and pyloric branches of the anterior vagal trunk) to maintain antral peristalsis and pyloric function. This avoids the need for a drainage procedure (pyloroplasty/gastrojejunostomy) and has the lowest dumping syndrome rate. Truncal vagotomy requires a drainage procedure because pyloric spasm develops.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.