What is a Puestow Procedure?
During a Puestow procedure, also known as a lateral pancreaticojejunostomy, the abdomen is opened with an incision from the lower breastbone to the belly button. The pancreas is exposed and the main pancreatic duct is opened from the head to the tail of the pancreas. The opened pancreatic duct is then connected to a loop of small intestine so that the pancreas drains directly into the intestines. This procedure has been done with much success in treating pain associated with chronic pancreatitis for over 50 years. With a success rate of 70 - 90 percent, this procedure has a low operative complication rate and a very low mortality rate.
Puestow with EHL
Many patients (with chronic pancreatitis) develop obstruction of the pancreatic duct associated with the formation of stones within it. When dilation of the pancreatic duct is associated with chronic pain, patients can be treated with the Peustow procedure. We have utilized intraoperative pancreatoscopy and electrohydraulic lithotripsy (EHL) for pancreatic ductal stones in combination with the Puestow procedure in order to clear the head of the pancreas of obstructing stones.
Although pancreatic duct stones may be removed by simple irrigation techniques, in some patients the stones are impacted in the head and are hard to remove. We have found that they can be easily removed by placing a small flexible scope into that part of the pancreatic duct and pulverizing the stones with shock waves.
Energy to make shock waves is delivered through a small wire that is placed through a small flexible scope in the pancreatic duct. We have utilized this technique for a number of years and found it to be successful in clearing pancreatic ductal stones. Good patient outcome measured in terms of pain relief has been seen. Although our results are early, we continue to utilize this technique in a routine fashion in patients who have stones impacted in the head of the pancreas whom are undergoing the Puestow procedure.