Enteric Ductal Drainage for Chronic Pancreatitis

Abstract

The concept of draining an apparently obstructed main pancreatic duct was first addressed by opening either the proximal end of the pancreatic duct at the ampulla, by doing a sphincterotomy, or the distal end of the pancreatic duct, by removing the tail of the pancreas and performing a pancreatojejunostomy (Duval procedure). Puestow is credited with the concept of a longitudinal incision along the main pancreatic duct, through the body and the head of the pancreas, after resecting the pancreatic tail. Partington and Rochelle determined that a tail resection was unnecessary and carried out only a side-to-side lateral pancreaticojejunostomy. The principle of the procedure is to decompress an apparently obstructed main pancreatic duct (and perhaps also to decompress the pancreatic parenchyma, overcoming the pancreatic compartment syndrome suggested by Reber). This assumption is based on the fact that the pancreatic duct is markedly dilated, suggesting a restriction to flow.