The Puestow procedure is a surgical technique

Surgery

Surgery is an ancient medical specialty that uses operative manual and instrumental techniques on a patient to investigate and/or treat a pathological condition such as disease or injury, or to help improve bodily function or appearance.An act of performing surgery may be called a surgical...

 used in the treatment of chronic pancreatitis

Chronic pancreatitis

Chronic pancreatitis is a long-standing inflammation of the pancreas that alters its normal structure and functions. It can present as episodes of acute inflammation in a previously injured pancreas, or as chronic damage with persistent pain or malabsorption....

. It involves a side-to-side anastomosis

Anastomosis

An anastomosis is the reconnection of two streams that previously branched out, such as blood vessels or leaf veins. The term is used in medicine, biology, mycology and geology....

 of the pancreatic duct

Pancreatic duct

The pancreatic duct, or duct of Wirsung , is a duct joining the pancreas to the common bile duct to supply pancreatic juices which aid in digestion provided by the "exocrine pancreas"...

 and the jejunum

Jejunum

The jejunum is the middle section of the small intestine in most higher vertebrates, including mammals, reptiles, and birds. In fish, the divisions of the small intestine are not as clear and the terms middle intestine or mid-gut may be used instead of jejunum.The jejunum lies between the duodenum...

.

Technique

The operation involves creating a longitudinal incision along the pancreas while the main pancreatic duct

Pancreatic duct

The pancreatic duct, or duct of Wirsung , is a duct joining the pancreas to the common bile duct to supply pancreatic juices which aid in digestion provided by the "exocrine pancreas"...

 is filleted open longitudinally from the head of the organ to its tail. The duct and pancreas are then attached to a loop of the small intestine

Small intestine

The small intestine is the part of the gastrointestinal tract following the stomach and followed by the large intestine, and is where much of the digestion and absorption of food takes place. In invertebrates such as worms, the terms "gastrointestinal tract" and "large intestine" are often used to...

 (pancreaticojejunostomy), which is oversewn to the exposed pancreatic duct in order to allow its drainage. When used in the appropriate setting, pain from chronic pancreatitis can improve. One advantage of this procedure compared to a Frey's procedure

Frey's procedure

Frey's procedure is a surgical technique used in the treatment of chronic pancreatitis in which the diseased portions of the pancreas head are cored out...

 is that pancreatic tissue is preserved, which may be of critical importance in patients with exocrine

Exocrine gland

Exocrine glands are a type of ductal glands that secrete their products into ducts that lead directly into the external environment...

 or endocrine insufficiency from their chronic pancreatitis.

Indications

A Puestow procedure is indicated for the treatment of symptomatic chronic pancreatitis patients with pancreatic ductal obstruction and a dilated main pancreatic duct. The main pancreatic duct needs to be 6mm in diameter in the body of the pancreas for this procedure to be possible.

Limitations

One of the problems that can lead to failure of the Puestow procedure is that pain can persist due to failure to drain the pancreatic duct on the head of the pancreas. A Frey's procedure

Frey's procedure

Frey's procedure is a surgical technique used in the treatment of chronic pancreatitis in which the diseased portions of the pancreas head are cored out...

is an alternative surgical procedure to the Puestow that allows for better drainage of the head, but pancreatic tissue is removed.

Additional reading

• Bapat RD, Satish R R, Kantharia CV. Choice Of Surgical Procedures for Chronic Pancreatitis. Bombay Hospital Journal. January 2001. Available at: http://www.bhj.org/journal/2001_4301_jan/reviews_175.htm. Accessed on: October 15, 2007.

External links

• Puestow's procedure (drawing) - Bombay Hospital Journal.