Puestow procedure

Puestow procedure, also known as longitudinal pancreaticojejunostomy, is a surgical technique primarily used to treat chronic pancreatitis. This procedure aims to relieve pain and manage complications associated with the disease by improving the drainage of the pancreatic duct.

Indications

The Puestow procedure is indicated for patients with chronic pancreatitis who suffer from persistent abdominal pain due to pancreatic duct obstruction. It is particularly beneficial for those with a dilated pancreatic duct, as it allows for effective drainage. This procedure is not suitable for patients with a non-dilated duct or those in whom the disease primarily affects the head of the pancreas.

Procedure

The Puestow procedure involves the longitudinal opening of the pancreatic duct along its entire length, followed by the creation of a side-to-side anastomosis between the duct and a loop of the jejunum (a part of the small intestine). This anastomosis facilitates the drainage of pancreatic enzymes directly into the intestine, bypassing the blockage and reducing the pressure and pain associated with pancreatitis.

Steps

1. A midline incision is made to open the abdomen. 2. The pancreas is exposed, and the dilated pancreatic duct is identified. 3. A longitudinal incision is made along the duct. 4. A loop of the jejunum is brought up to the pancreas. 5. The jejunal loop is opened, and a side-to-side anastomosis with the opened pancreatic duct is performed using sutures.

Complications

As with any surgical procedure, the Puestow procedure carries risks and potential complications, including:

• Infection
• Bleeding
• Leakage from the anastomosis site
• Delayed gastric emptying
• Diabetes, if a significant portion of the pancreas is removed or if the pancreatic islets are damaged

Outcomes

The Puestow procedure has been shown to provide significant pain relief in a majority of patients with chronic pancreatitis. It also helps in managing complications such as pancreatic pseudocysts. However, the success of the procedure largely depends on the patient's condition, including the extent of the disease and the presence of a dilated pancreatic duct.

See Also

• Chronic pancreatitis
• Pancreatic duct
• Pancreaticojejunostomy
• Pancreatitis