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Laparoscopic Puestow: lateral pancreaticojejunostomy

Abstract

Introduction

Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis.

Methods

A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique.

Results

The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1–2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years.

Conclusion

The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life.

References

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    D’Haese JG, Ceyhan GO, Demir IE, Tieftrunk E, Friess H (2014) Treatment options in painful chronic pancreatitis: a systematic review. HBP (Oxford) 16(6):512–521

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    Sukharamwala PB, Patel KD, Teta AF, Parikh S, Ross SB, Carrie E, Rosemurgy AS (2015) Long-term outcomes favor duodenum-preserving pancreatic head resection over pylorus-preserving pancreaticoduodenectomy for chronic pancreatitis: a meta-analysis and systematic review. Am Surg 81(9):909–914

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    Peustow CB, Gillesby WJ (1958) Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 76(6):898–907

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Author information

Correspondence to Benjamin R. Biteman.

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Supplementary material 1 (MP4 479821 kb)

Supplementary material 1 (MP4 479821 kb)

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Biteman, B.R., Harr, J.N. & Brody, F. Laparoscopic Puestow: lateral pancreaticojejunostomy. Surg Endosc 30, 5624 (2016). https://doi.org/10.1007/s00464-016-4920-z

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Keywords

  • Chronic Pancreatitis
  • Calcify Stone
  • Pancreatic Head Resection
  • Dilate Pancreatic Duct
  • Chronic Alcohol Abuse