**Core Concept**
Truncal vagotomy with gastrojejunostomy is a surgical procedure that involves cutting the vagus nerve to reduce acid production in the stomach and creating a new connection between the stomach and jejunum to bypass the obstructed portion of the stomach. This operation is often performed in cases of gastric outlet obstruction due to peptic ulcer disease, where the obstruction prevents normal emptying of the stomach.

**Why the Correct Answer is Right**
The correct answer, truncal vagotomy with gastrojejunostomy, is the most effective operation for gastric outlet obstruction with peptic ulcer disease. This is because truncal vagotomy effectively reduces acid production by severing the vagus nerve, which stimulates the parietal cells in the stomach to secrete gastric acid. Gastrojejunostomy creates a new pathway for food to bypass the obstructed portion of the stomach, allowing for normal digestion and absorption of nutrients. The combination of these two procedures addresses both the acid production and the mechanical obstruction, making it the most effective treatment for this condition.

**Why Each Wrong Option is Incorrect**
**Option A:** This option is a repeat of the correct answer and should be ignored.
**Option B:** This option is a repeat of the correct answer and should be ignored.
**Option C:** Highly selective vagotomy with pyloroplasty is not the most effective operation for gastric outlet obstruction with peptic ulcer disease. While highly selective vagotomy reduces acid production, it does not address the mechanical obstruction as effectively as gastrojejunostomy. Pyloroplasty may also not be sufficient to bypass the obstruction.
**Option D:** Gastrojejunostomy alone is not sufficient to treat gastric outlet obstruction with peptic ulcer disease, as it does not address the underlying acid production that is contributing to the obstruction.

**Clinical Pearl / High-Yield Fact**
When considering surgical options for gastric outlet obstruction with peptic ulcer disease, it is essential to remember that truncal vagotomy with gastrojejunostomy is the most effective operation, as it addresses both acid production and mechanical obstruction. This operation is often preferred over highly selective vagotomy with pyloroplasty, as it provides a more comprehensive solution to the underlying problem.

**✓ Correct Answer: A. Truncal vagotomy with gastrojejunostomy**