title: "Puestow modified procedure in the era of advanced endoscopic interventions for the management of chronic lithiasic pancreatitis. A two cases report".
abstract: BACKGROUND
  Pancreatic duct calculi in chronic pancreatitis (CP) patients are the main cause of intractable pain which is their main symptom. Decompression options of for the main pancreatic duct are both surgical and advanced endoscopic procedures.
  
  
  METHODS
  A 64-year-old male with known CP due to alcohol consumption and a 36-year-old female with known idiopathic CP and pancreatic duct calculi were managed recently in our hospital where endoscopic procedures were unsuccessful. A surgical therapy was considered and a longitudinal pancreaticojejunostomy (modified Puestow procedure) in both patients was performed with excellent results.
  
  
  CONCLUSIONS
  Over the last 30 years, endoscopic procedures are developed to manage pancreatic duct strictures and calculi of the main pancreatic duct in CP patients. In both of our cases endoscopic therapy was first attempted but failed to extract the pancreatic duct stones, due to their size and speculations. Modified Puestow procedure was performed for both and it was successful for long term pain relief.
  
  
  CONCLUSIONS
  Despite advancement in endoscopic interventions and less invasive therapies for the management of chronic lithiasic pancreatitis we consider that classic surgical management can be appropriate in certain cases.
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece. Electronic address: gfragulidis@aretaieio.uoa.gr.
authors: Georgios P
authors: GP
authors: Fragulidis
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Αntonios
authors: Α
authors: Vezakis
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Dionissios
authors: D
authors: Dellaportas
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Ira
authors: I
authors: Sotirova
authors: 1st Department of Radiology, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Vassilis
authors: V
authors: Koutoulidis
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Elliseos
authors: E
authors: Kontis
authors: 2nd Department of Surgery, Aretaieio Hospital, University of Athens, Medical School, Athens, Greece.
authors: Andreas
authors: A
authors: Polydorou
keywords: Chronic lithiasic pancreatitis; Endoscopy; Modified Puestow procedure; Pancreatic duct calculi; Partington-Rochelle procedure; Surgical treatment