Puestow'sProcedure Performed During Gastric Conduit Harvesting. Esophageal cancer survival has improved as a result of improvements in surgical techniques and preoperative chemoradiation. Excessive alcohol consumption is a shared risk factor for esophageal cancer and chronic alcoholic pancreatitis. Puestow'sprocedure is a treatment choice for pain relief and pancreatic duct decompression . It is logical to perform Puestow'sprocedure in patients undergoing esophagectomy with underlying chronic pancreatitis to preserve pancreatic function and restore quality of life in the setting of improved overall survival of patients with esophageal cancer. This report describes a preliminary experience with 2 patients who underwent both procedures during the same operation and achieved acceptable outcomes.
Robotic pancreas drainage procedure for chronic pancreatitis: robotic lateral pancreaticojejunostomy (Puestowprocedure) Lateral pancreaticojejunostomy (LPJ), also known as the Puestowprocedure, is a complex surgical procedure reserved for patients with refractory chronic pancreatitis (CP) and a dilated pancreatic duct. Traditionally, this operation is performed through an open incision, however
Modified Puestowprocedure for the management of chronic pancreatitis in children. To present our experience with the modified Puestowprocedure in the management of children with chronic pancreatitis. Retrospective chart review of patients treated between 2003 and 2012. Six patients underwent a modified Puestowprocedure (lateral pancreaticojejunostomy) for the management of chronic chronic pancreatitis). We conclude that the modified Puestowprocedure in children is feasible and safe. It seems to provide definitive pain control and prevent further damage to the pancreas in patients with obstructive chronic pancreatitis. However, in patients with hereditary pancreatitis, pain control outcomes are variable and the operation may not abrogate the progression of disease to pancreatic
The PuestowProcedure: How I Do It. The Puestowprocedure, also called lateral pancreaticojejunostomy, has been the mainstay of surgical therapy for dilated duct chronic pancreatitis for decades. Principles that Puestow and Gillesby described in 1958 are pertinent to the modern conduct of this operation that is described with current practice guidelines.
). 3.5.5 Surgery • In the current era, the vast majority of interventional management for pancreatitis or its associated complications is done via ERCP and /or EUS and referral to a specialist paediatric hepatobiliary surgical team is highly recommended. • A pancreaticojejunostomy or Puestowprocedure may be indicated in patients with ARP or CP and ductal abnormalities, which are refractory
dilation withouta coinciding inflammatory pancreatic head mass, a longitudinalpancreaticojejunostomy, or ‘‘modified Puestow’’ procedure,(Fig. 2) may be an effective drainage operation (16). This techniquemay be considered when the main pancreatic duct is substantiallydilated to at least 7 mm in size, with relatively uniform dilation fromthe head to the tail of the pancreas. Although a surgical relief in those withenlargement of the pancreatic head (50). Even in the absence ofan inflammatory head mass, the modified Puestowprocedure has,however, fallen out of favor as a drainage procedure in manyexperienced pancreas centers, having been replaced by the Freyprocedure (Fig. 3), which adds a limited coring out of the pancreatichead in continuity with a longitudinal pancreaticojejunostomy
Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique. Chronic pancreatitis (CP) is a debilitating condition resulting in severe pain with progressive deterioration of pancreatic function. "Tropical" pancreatitis represents a variant of the disease with widely dilated ducts, numerous calculi, and few strictures. Traditionally, modified Puestow'sprocedure has been the treatment of choice for a dilated pancreatic ductal system. However, it has only recently been adapted to laparoscopic approach which is a technically demanding procedure primarily due to need for extensive intra-corporeal suturing. Symptomatic cases of CP presenting at our center with minimum 8 mm mean ductal diameter at body and head were selected for laparoscopic modified Puestow'sprocedure. Those
and reconstructions 39 were for CP indications. These included 11 total pancreatectomies [with and without auto islet transplantation], 8 Puestowprocedures, 4 Frey procedures, 6 pancreaticoduodenectomies, and 10 distal pancreatectomies. Median age was 49, and 41% of the patients were female. The most common etiology for CP was idiopathic pancreatitis (n = 16, 46%). Median operative time was 324 min with a median
Laparoscopic Puestow: lateral pancreaticojejunostomy. 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 Puestowprocedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures
patients recovered without significant complications or relapse of pancreatitis. The follow-up period was 4-21 months. Our new laparoscopic longitudinal anterior pancreaticojejunostomy technique (Puestowprocedure) using barbed sutures is a potentially efficient and minimally invasive procedure for patients who suffer from pancreatic duct obstruction and chronic pancreatitis.
who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P < 0.001). The relief from narcotics was sustained. Of the 75 patients undergoing TP-IAT, 31 (41.3%) achieved insulin independence. Younger age (P = 0.032), lack of prior Puestowprocedure (P = 0.018), lower body surface
in children is controversial. Indications for operative intervention include unsuccessful conservative medical therapy, intractable pain, impaired nutrition, and narcotic addiction. Surgical options include distal pancreatectomy with Roux-en-Y pancreaticojejunostomy (ie, Duval procedure), lateral pancreaticojejunostomy (ie, Puestowprocedure), or ERCP sphincteroplasty. Recently, a few pediatric patients
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in children is controversial. Indications for operative intervention include unsuccessful conservative medical therapy, intractable pain, impaired nutrition, and narcotic addiction. Surgical options include distal pancreatectomy with Roux-en-Y pancreaticojejunostomy (ie, Duval procedure), lateral pancreaticojejunostomy (ie, Puestowprocedure), or ERCP sphincteroplasty. Recently, a few pediatric patients