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.
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.
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