Longitudinal Pancreaticojejunostomy (Puestow Procedure)
OPERATION: Longitudinal Pancreaticojejunostomy (Puestow Procedure)
ANAESTHETIC: General anaesthesia
ANTIBIOTICS: IV cephalosporin at induction. VTE prophylaxis.
POSITION: Supine. Nasogastric tube and urinary catheter. Intraoperative USS available.
INDICATION:
Chronic pancreatitis with refractory pain unresponsive to medical management. Preoperative imaging confirms dilated main pancreatic duct (typically >7 mm) throughout a generally atrophic gland — duct dilation extends from head to tail. [Previous endoscopic treatment failed]. Preoperative analgesia and nutritional optimisation performed.
PROCEDURE:
WHO Checklist performed. Bilateral subcostal incision with upper retractor system.
PANCREATIC EXPOSURE: