The Puestow Procedure in Chronic Pancreatitis: A Narrative Review
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Abstract
Chronic pancreatitis is a progressive inflammatory disease characterized by persistent abdominal pain, exocrine and endocrine insufficiency, and impaired quality of life. Although medical and endoscopic therapies may provide symptom control in selected patients, surgery remains a cornerstone in those with refractory pain and structural ductal disease. The Puestow procedure, also known as lateral pancreaticojejunostomy (LPJ), is a well-established surgical option for patients with chronic pancreatitis and a dilated main pancreatic duct. This narrative review summarizes the indications, technical principles, outcomes, complications, and evolving minimally invasive approaches of the Puestow procedure, based on current literature. Emphasis is placed on patient selection and the role of LPJ within modern multidisciplinary management strategies for chronic pancreatitis.
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References
I. Napolitano M, Brody F, Lee KB, et al. 30-day outcomes and predictors of complications after Puestow procedure. Am J Surg. 2020;220(2):372-375. doi:10.1016/j.amjsurg.2019.12.024
II. Biteman BR, Harr JN, Brody F. Laparoscopic Puestow: lateral pancreaticojejunostomy. Surg Endosc. 2016;30(12):5624. doi:10.1007/s00464-016-4920-z
III. Adams DB. The Puestow procedure: how I do it. J Gastrointest Surg. 2013;17(6):1138-1142. doi:10.1007/s11605-012-2101-5
IV. Laje P, Adzick NS. Modified Puestow procedure for the management of chronic pancreatitis in children. J Pediatr Surg. 2013;48(11):2271-2275. doi:10.1016/j.jpedsurg.2013.03.048
V. Meehan JJ, Sawin R. Robotic lateral pancreaticojejunostomy (Puestow). J Pediatr Surg. 2011;46(6):e5. doi:10.1016/j.jpedsurg.2011.03.003
VI. Ceppa EP, Pappas TN. Modified Puestow lateral pancreaticojejunostomy. J Gastrointest Surg. 2009;13(5):1004-1008. doi:10.1007/s11605-008-0590-z
VII. Nathan JD, Ellery K, Balakrishnan K, et al. The role of surgical management in chronic pancreatitis in children: a position paper from the NASPGHAN Pancreas Committee. J Pediatr Gastroenterol Nutr. 2022;74(5):706-711. doi:10.1097/mpg.0000000000003439
VIII. Bhandarwar A, Arora E, Gajbhiye R, et al. Laparoscopic lateral pancreaticojejunostomy: an evolution to endostapled technique. Surg Endosc. 2019;33(6):1749-1756. doi:10.1007/s00464-018-6434-3
IX. Shah AA, Petrosyan M, Kane TD. Lateral pancreaticojejunostomy for chronic pancreatitis and pancreatic ductal dilation in children. J Laparoendosc Adv Surg Tech A. 2018;28(11):1397-1402. doi:10.1089/lap.2018.0136
X. Balduzzi A, Zwart MJW, Kempeneers RMA, et al. Robotic lateral pancreaticojejunostomy for chronic pancreatitis. J Vis Exp. 2019;(154):e60301. doi:10.3791/60301
XI. Cohen SM, Kent TS. Etiology, diagnosis, and modern management of chronic pancreatitis: a systematic review. JAMA Surg. 2023;158(6):652-661. doi:10.1001/jamasurg.2023.0367
XII. Freed KS, Paulson EK, Frederick MG, et al. Abdomen after a Puestow procedure: postoperative CT appearance, complications, and potential pitfalls. Radiology. 1997;203(3):790-794. doi:10.1148/radiology.203.3.9169706