What is a longitudinal pancreaticojejunostomy (Puestow procedure)?
A longitudinal pancreaticojejunostomy (LPJ or Puestow procedure) is a surgical procedure to create an artificial passage connecting the pancreas to the second part of the small bowel (jejunum). The procedure is generally performed in refractory cases of chronic pancreatitis, which is the inflammation of the pancreas that does not heal or improve.
The disease eventually impairs a person’s ability to digest food and other body functions because of the deficiency of pancreatic hormones (such as insulin that regulates blood sugar). The most common symptom of chronic pancreatitis is pain, which can be severe and stubborn in some people.
A longitudinal pancreaticojejunostomy may be considered in patients whose condition did not improve or worsened with nonsurgical management of chronic pancreatitis, such as enzyme replacement, control of diabetes with insulin, and administration of painkillers.
The procedure not only eliminates the symptoms and improves the quality of life but also reduces the risk of complications, such as bowel obstruction, jaundice, and cancer of the pancreas.
Who needs a longitudinal pancreaticojejunostomy?
A longitudinal pancreaticojejunostomy (LPJ) can be performed in patients with chronic pancreatitis who
- report severe pain resistance to conventional nonsurgical therapy,
- have associated or suspected malignancy (cancer), or
- have developed complications such as a bile duct or bowel obstruction, pancreatic fistulae (leakage of pancreatic fluid as a result of disruption of the pancreatic ducts) and ascites (excessive collection of fluid in the abdomen).
What happens during a longitudinal pancreaticojejunostomy (Puestow procedure)?
The procedure is typically performed by a gastrointestinal (GI) surgeon under general anesthesia.
Before the surgery
Your doctor may
- Order some blood tests and imaging studies (such as ultrasonography, CT scan and endoscopic imaging)
- Ask you about any chronic health conditions
- Ask you about any medications you are on
- Ask about any allergies you may have
- Explain the surgical procedure in detail, including possible complications and address your doubts and concerns related to the surgery
- Obtain your written consent
- Ask you to not eat anything for at least eight hours before the procedure
- Ask you to abstain from alcohol before and after the surgery
- Ask you to take medications for anxiolytics (keeping you calm) and reduce proton pump inhibitors (PPIs) (acid formation in the stomach)
- Ask you to take antibiotics and painkillers
During the procedure
- You will be asked to wear a hospital gown.
- You will lie on your back on the operation table.
- The anesthesiologist will attach an intravenous (IV) line and administer general anesthesia.
- The surgeon will clean the skin with an antiseptic and make an incision (a surgical cut) on the abdomen either under the lower border of the ribcage or in the midline.
- The surgeon gains access to the pancreatic duct and the jejunum (the second part of the small bowel) and connects them with sutures in a way that bowel continuity is not compromised.
- Additional corrections such as the removal of stones from the pancreatic duct and obstruction in the small bowel may also be done if needed.
- When the repair is completed, the incision is closed with stitches and covered with a bandage.
After the surgery
- Your vital signs will be monitored.
- Nasogastric decompression (removal of stomach secretions through a tube placed into the stomach through the nose) is continued until bowel function resumes.
- Oral intake is resumed when bowel function is optimal.
QUESTION
Pancreatitis is inflammation of an organ in the abdomen called the pancreas. See AnswerHealth Solutions From Our Sponsors
Top What Is a Longitudinal Pancreaticojejunostomy Related Articles
Detectnet (copper Cu 64 dotatate)
Detectnet (copper Cu 64 dotatate) binds to somatostatin receptors that are the hallmark of neuroendocrine tumors (NETs). Detectnet settles in the tissues and the tumor receptors absorb it. The copper molecules act as a radioactive beacon that doctors can see on a PET scan image. Based upon the intensity of the signals, PET images obtained using copper Cu 64 dotatate injection indicate the presence and density of somatostatin receptors, showing neuroendocrine tumors in the body as a result.
Diarrhea
Diarrhea is a change in the frequency and looseness of bowel movements. Symptoms associated with diarrhea are cramping, abdominal pain, and the sensation of rectal urgency. Causes of diarrhea include viral, bacterial, or parasite infection, gastroenteritis, food poisoning, and drugs. Absorbents and anti-motility medications are used to treat diarrhea.digestive enzymes
Digestive enzymes are natural substances that help the digestive system break down food. Taken as a supplement, digestive enzymes may be used to treat adults and children with pancreatic insufficiency caused by cystic fibrosis, chronic pancreatitis (inflammation of the pancreas), pancreatectomy (removal of all or part of the pancreas), or pancreatic cancer. Common side effects of digestive enzymes include headache, neck pain, dizziness, abdominal cramping, nausea, diarrhea, gas (flatulence), indigestion, abnormal stools, and others. Do not take if you have acute pancreatitis.
Diverticulitis (Diverticulosis)
Most people with diverticulosis have few if any symptoms at all. When people do experience signs and symptoms of diverticulosis (diverticular disease) they may include abdominal pain, abdominal cramps, diarrhea, constipation, and bloating. Diverticulitis is a condition in which diverticula in the colon rupture. The rupture results in infection in the tissues that surround the colon. Treatment methods for diverticulitis include prescription medications, and in some cases, diverticulitis surgery.
Intestinal Gas and Gas Pain
Intestinal gas and painful bloating are common. Learn about what causes gas pain and how eliminating certain foods from your diet can help relieve symptoms.
Pancreas Divisum
Pancreas divisum is a common congenital anomaly (an anomaly that is present at birth) of the pancreatic duct(s). The human embryo starts life with two ducts in the pancreas; the ventral duct and the dorsal duct. In more than 90% of the embryos, the dorsal and the ventral ducts will fuse to form one main pancreatic duct. In approximately 10% of embryos, the dorsal and the ventral ducts fail to fuse. Failure of the ventral and the dorsal pancreatic ducts to fuse is called pancreas divisum (because the pancreas is drained by two ducts). In pancreas divisum, the ventral duct drains into the major papilla, while the dorsal duct drains into a separate minor papilla. The majority of individuals born with pancreas divisum experience no symptoms throughout life, will remain undiagnosed and will not require treatment. A small number of patients with pancreas divisum will experience repeated episodes of pancreatitis.
Pancreas Picture
A fish-shaped spongy grayish-pink organ about 6 inches (15 cm) long that stretches across the back of the abdomen, behind the stomach. See a picture of the Pancreas and learn more about the health topic.
Acute and Chronic Pancreatitis
Pancreatitis is a rare disease in which the pancreas becomes inflamed. There are two types of pancreatitis: acute and chronic. Symptoms of pancreatitis include abdominal pain, fever, nausea, vomiting, and a rapid pulse. Treatment of pancreatitis often requires hospitalization.
Pancreatitis Quiz
What does the pancreas do, and what happens in the body that causes pancreatitis? Test your medical IQ of pancreatitis with this quiz!
How Long Does It Take to Recover From a Pancreas Surgery?
Laparoscopic pancreatectomy can be used in the treatment of a number of different conditions which include tumors and severe pancreatitis.
What Are the Different Procedures That Constitute a Whipple Procedure?
The Whipple procedure removes pancreatic cancer or a tumor. The surgeon removes the head of the pancreas, the gallbladder and the first section of the small intestine (the duodenum). Occasionally, a small part of the stomach is also removed. The Whipple procedure is also called pancreaticoduodenectomy.
Why Is a Spleen Removed in a Distal Pancreatectomy?
A pancreatosplenectomy (pancreaticosplenectomy) or spleen-preserving distal pancreatectomy is performed to surgically treat the pancreatic disease of the tail and body. A distal pancreatectomy involves surgical resection of the body and tail of the pancreas with or without splenectomy. The surgery is performed under general anesthesia. Complications include pancreatic leak, pancreatic fistula, abdominal abscess, infection, bleeding, small bowel obstruction, new-onset insulin-dependent diabetes, problems with digestion, change in bowel habits, and loss of appetite and weight.