A 40-year-old woman with severe chronic pancreatitis is scheduled to undergo an operation, because other forms of treatment have failed. The ultrasound shows no evidence of pseudocyst formation or cholelithiasis and endoscopic retrograde cholangiopancreatogram (ERCP) demonstrates dilated pancreatic ducts with multiple stricture formation. Which operation is suitable to treat this condition?
If the pancreatic duct is dilated and symptoms persist, a longitudinal pancreaticojejunostomy (Puestow) is performed (Figure below). In this operation, the pancreatic duct is slit open and anastomosed side-to-side to the cut end of the divided jejunum with a Roux-en-Y anastomosis. Resection of the pancreas is reserved for patients without a dilated duct (<6 mm). In these cases, a distal pancreatectomy is performed when the disease primarily involves the body and tail of the pancreas; whereas, a Whipple operation is performed when the disease is confined to the head.Lateral pancreatic jejunostomy (Puestow) for chronic pancreatitus
Pancreatic jejunostomy (Puestow procedure)
Gastrojejunostomy
Cholecystectomy
Splenectomy
Pancreas