Type of Surgery

Chronic Pancreatitis Surgery - Puestow Procedure

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Last updated: 01/31/2010

Chronic pancreatitis can be an extremely painful, life-long disease. Various medical interventions, such as replacement pancreatic enzymes can work for a while, but can be expensive over time. Also, artificial enzymes do not necessarily prevent painful pancreatitis flare-ups. Surgery for chronic pancreatitis can be more effective, but all the available procedures represent major surgery and have their own issues with complications and recovery. One of the commonly performed surgical procedures for chronic pancreatitis is the Puestow procedure.

 

The Puestow procedure, also known as a lateral pancreaticojejunostomy, is a procedure that connects the pancreas directly to the small intestine. Unlike other chronic pancreatitis surgeries, a Puestow is rather involved since the entire pancreatic duct is cut lengthwise and sutured into the intestine. In one respect, the Puestow surgery is advantageous because the entire pancreatic duct is opened leaving little chance for an obstruction (and obstruction is the primary cause of chronic pancreatitis). Therefore, as digestive enzymes are created by the pancreas, they are released directly into the intestine.

On the other hand, a Puestow is a fairly major revision of the anatomy of the pancreas. It is best reserved for patients that have a pancreatic duct of a certain diameter-a diameter that is usually only reached through years of chronic obstruction, inflammation, and swelling.

The original Puestow procedure involved removing the spleen and cutting the tail off of the pancreas so that the intestine could be placed around the end of the now open, shorter pancreas. The pancreatic duct was still cut lengthwise in the original Puestow. A newer modification proposed by surgeons Partington and Rochelle is the version of the Puestow surgery that is performed most often today. In the modified Puestow, the spleen is usually spared along with most, if not all of the pancreas.

Patients report an essentially immediate relief of pain upon waking from general anesthesia. People that have struggled with the severe, debilitating pain of chronic pancreatitis have such a resolution of pain that some of early reports on the Puestow procedure (specifically the modified Puestow) state that patients did not require narcotic painkillers (like morphine) for postoperative pain. When performed successfully, the Puestow surgery can provide profound pain relief.

Despite success with the Puestow surgery, there are some patients that have recurrent episodes of pancreatitis. However, any recurrence of pancreatitis after the Puestow is quite mild and easily treated when compared to the pain experienced before the procedure.

The most likely complication from Puestow surgery, other than infection and fluid accumulation, is that the sutures on the pancreas and intestine may leak or become loose. This risk is reduced with careful surgical technique but is increased in patients that try to do too much, too soon after surgery. Since patients enjoy such a dramatic relief from pain, they are tempted to exert themselves too soon after the Puestow. Since there are a number of long-running sutures in the procedure, there are ample places for leakage. Pancreatic enzymes that leak from the Puestow suture can cause significant problems within the abdominal cavity but, fortunately, this surgical complication is rare. The risk of this complication is reduced even further by observing the restrictions that are placed on activity during Puestow recovery.

 


Last Updated: 01/31/2010

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