Laparoscopic Lateral Pancreaticojejunostomy

Jeffrey N Harr, MD, MPH, Jeremy Holzmacher, MD, Benjamin Biteman, MD, Fred Brody, MD, MBA. The George Washington University

INTRODUCTION – A lateral pancreaticojejunostomy, also known as the Puestow procedure, is a complex surgery performed for symptomatic chronic pancreatitis with a dilated pancreatic duct.  An open approach is traditionally used due to the complexity of the case, and there have only been a handful of laparoscopic case reports published.  

METHODS AND PROCEDURES –  We present a laparoscopic lateral pancreaticojejunostomy in a 45-year old gentleman with chronic pancreatitis.  A computed tomography scan revealed multiple calcified deposits within 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 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 jejunojejunostomy was completed using a stapled technique.

RESULTS – The patient had a relatively uncomplicated hospital course.  He developed a postoperative ileus, but had return of bowel function on postoperative day 4.  He was discharged home on postoperative day 5.  On 12-month follow-up, he remains off narcotics, but still requires 1-2 tabs of pancreatic enzyme replacement per meal.

CONCULUSION – A laparoscopic lateral pancreaticojejunostomy is an effective approach in appropriate patients with few complications and a short hospital course.

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