Surgical Endoscopy

, Volume 30, Issue 12, pp 5624–5624 | Cite as

Laparoscopic Puestow: lateral pancreaticojejunostomy

  • Benjamin R. BitemanEmail author
  • Jeffrey N. Harr
  • Fred Brody



Chronic pancreatitis is a painful inflammatory disease that leads to progressive and irreversible destruction of pancreatic parenchyma [1]. A lateral pancreaticojejunostomy, also known as the Puestow procedure, is performed for symptomatic chronic pancreatitis associated with a dilated pancreatic duct secondary to calcifications or strictures [4]. An open approach is used traditionally due to the complexity of the case, and there have only been a handful of laparoscopic case reports [2]. This video depicts a laparoscopic lateral pancreaticojejunostomy for chronic pancreatitis.


A 45-year-old gentleman with a 20-year history of chronic alcohol abuse presented with diffuse abdominal pain. His pain was worse postprandially and associated with loose stools. A computed tomography scan revealed multiple calcified deposits within the body and tail of the pancreas, and a dilated pancreatic duct measuring 1.4 cm with a proximal obstructing calcified stone. A 5-port foregut technique was used, and a 15-cm pancreatic ductotomy was performed with an ultrasonic scalpel. Calcified stones were cleared from the duct, and a roux-en-y pancreaticojejunostomy was performed using a hand-sewn technique.


The patient had a relatively uncomplicated hospital course with return of bowel function on postoperative day 4. His patient-controlled analgesic device was discontinued on post operative day 3. He was ambulating, tolerating a regular diet and discharged home on postoperative day 5. At 12- and 26-month follow-up, he remains off narcotics, but still requires 1–2 tabs of pancreatic enzyme replacement per meal. Most importantly, he has not had any alcohol for over 2 years.


The two primary goals in treating chronic pancreatitis include long-term pain relief and improvements in quality of life [3]. For patients with chronic pancreatitis and a dilated pancreatic duct, a laparoscopic lateral pancreaticojejunostomy may be an effective approach to decrease pain and improve quality of life.


Chronic Pancreatitis Calcify Stone Pancreatic Head Resection Dilate Pancreatic Duct Chronic Alcohol Abuse 
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Supplementary material

Supplementary material 1 (MP4 479821 kb)


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Copyright information

© Springer Science+Business Media New York 2016

Authors and Affiliations

  • Benjamin R. Biteman
    • 1
    Email author
  • Jeffrey N. Harr
    • 1
  • Fred Brody
    • 1
  1. 1.Department of Surgery, Medical Faculty AssociatesThe George Washington University Medical CenterWashingtonUSA

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