A 45-year-old man with duodenal ulcer undergoes truncal vagotomy. Why is a drainage procedure (pyloroplasty or gastrojejunostomy) mandatory after this operation?
- A Truncal vagotomy abolishes pancreatic enzyme secretion
- B Truncal vagotomy causes severe bile reflux requiring diversion
- C Truncal vagotomy denervates the pylorus causing gastric outlet obstruction ✓
- D Truncal vagotomy causes severe diarrhea requiring a stoma
Correct answer: C. Truncal vagotomy denervates the pylorus causing gastric outlet obstruction
Explanation
Truncal vagotomy denervates the pylorus, impairing gastric emptying and causing gastric outlet obstruction (stasis). C drainage procedure (pyloroplasty or gastrojejunostomy) is therefore mandatory. Highly selective vagotomy (HSV) preserves pyloric innervation and does not require drainage. Bile reflux and diarrhea are consequences but do not mandate a drainage procedure.
Reference: Bailey and Love's Short Practice of Surgery, 28th ed.
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