Surgery of choice for chronic duodenal ulcer is –
**Core Concept**
Highly selective vagotomy (HSV) is a surgical procedure that involves the selective division of vagal fibers supplying the stomach, specifically targeting the branches innervating the antrum and pylorus. This technique aims to reduce gastric acid secretion while preserving the function of the remaining vagal branches to the fundus, thereby minimizing the risk of complications such as dumping syndrome and diarrhea.
**Why the Correct Answer is Right**
HSV is preferred for treating chronic duodenal ulcers due to its targeted approach to reducing acid secretion. The procedure involves the selective division of the vagal fibers to the antrum and pylorus, which are the primary sources of gastrin release and acid production. By preserving the vagal innervation to the fundus, HSV helps maintain the normal physiological response to meals, reducing the risk of complications associated with more extensive vagotomy procedures. The preservation of the vagal branches to the fundus also helps maintain the normal physiological response to meals, reducing the risk of complications associated with more extensive vagotomy procedures.
**Why Each Wrong Option is Incorrect**
**Option A:** Vagotomy + antrectomy involves the removal of the antrum, which is not only unnecessary but also increases the risk of complications such as malabsorption and vitamin B12 deficiency. **Option B:** Total gastrectomy is a radical procedure that involves the removal of the entire stomach, which is not indicated for chronic duodenal ulcers and carries significant risks of complications such as malabsorption and weight loss. **Option C:** Truncal vagotomy + pyloroplasty involves the division of the main vagal trunk and the creation of a pyloric channel, which increases the risk of complications such as dumping syndrome and diarrhea.
**Clinical Pearl / High-Yield Fact**
HSV is a preferred surgical option for chronic duodenal ulcers because it balances the reduction of acid secretion with the preservation of normal physiological responses to meals, minimizing the risk of complications.
**✓ Correct Answer: D. Highly selective vagotomy**