Compared with a highly selective vagotomy, a truncal vagotomy performed for peptic ulcer disease carries two complications that the selective procedure largely avoids. Which pair?

• A Recurrent ulceration and gastric outlet obstruction
• B Postvagotomy diarrhoea and cholelithiasis ✓
• C Dumping syndrome and alkaline reflux gastritis
• D Afferent loop syndrome and stomal ulceration

Explanation

Truncal vagotomy denervates the entire abdominal foregut, including the pylorus and biliary tree. Loss of pyloric coordination causes rapid gastric emptying of hyperosmolar contents, producing postvagotomy diarrhoea, and vagal denervation of the gallbladder impairs contraction, promoting cholesterol stone formation. Highly selective vagotomy divides only the parietal cell vagal fibres, sparing the nerves of Latarjet and the hepatic and coeliac branches, so these complications are largely avoided.

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

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

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