Which operative procedure for chronic duodenal ulcer carries the lowest recurrence rate, and why does it require no separate drainage procedure?

• A Truncal vagotomy alone, because pyloric function is preserved
• B Highly selective vagotomy, because antral motility is preserved
• C Billroth I gastrectomy, because vagal innervation remains intact
• D Truncal vagotomy with antrectomy, because the entire acid-producing antrum is removed ✓

Explanation

Truncal vagotomy with antrectomy achieves the lowest recurrence rate of all elective ulcer operations, roughly 0 to 1 percent, because it removes both the cephalic (vagal) phase and the hormonal (gastrin-driven) phase of acid secretion. However, truncal vagotomy denervates the pylorus, so antral resection doubles as the drainage procedure and no separate pyloroplasty is needed. Highly selective vagotomy preserves motility and needs no drainage but has a higher recurrence rate around 10 percent.

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

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Written and medically reviewed by the StethoPrep medical team.