Nerves of latarjet are spared in -

Ans. is 'a' i.e., Highly selective vagotomy o Types of vagotomy1) Highly selective vagotomy (HSV)2) Vagotomy and drainage (V+D)3) Vagotomy and antrectomy (V+A)o Vagotomy is a component of each of these procedures. It decreases the acid secretion by stopping cholinergic input into the stomach. But since vagus nerve is also the motor supply of stomach and the antropyloroduodenal segment a truncal vagotomy leads to gastric stasis.o Gastric stasis is prevented by adding a drainage procedure to the truncal vagotomy (Vagotomy & drainage - V+ D). Drainage procedure used are :# Gastrojejunostomy# Pyloroplastyo In Highly selective vagotomy (also known as parietal cell vagotomy or proximal gastric vagotomy) the vagal innervation to the antrum and pylorus (nerves of Latarjet) are preserved, only the vagal supply to the proximal two- thirds of stomach (where essentially all the parietal cells are located) is cut. This preserves gastric motilityo Advantages# Technical simplicity & preservation of entire gastric reservoir capacity.# Lowest mortality and side effects# Minimal chances of dumping syndromeo Disadvantage# Recurrence rates are higher than V + D or V + A.o Vagotomy plus antrectomy# In this operation a distal gastrectomy (about 50% of stomach) is done. This removes almost all the gastrin producing mucosa, thus acid reduction is maximum in this operation.o Advantages - lowest recurrance rateo Disadvantage - high mortality & morbidity