title: Laparoscopic Puestow: lateral pancreaticojejunostomy.
abstract: 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.
authors.affiliation: Department of Surgery, Medical Faculty Associates, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, 6th Floor, Washington, DC, 20073, USA. brbiteman@gmail.com.
authors.forename: Benjamin R
authors.initials: BR
authors.lastname: Biteman
authors.affiliation: Department of Surgery, Medical Faculty Associates, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, 6th Floor, Washington, DC, 20073, USA.
authors.forename: Jeffrey N
authors.initials: JN
authors.lastname: Harr
authors.affiliation: Department of Surgery, Medical Faculty Associates, The George Washington University Medical Center, 2150 Pennsylvania Ave NW, 6th Floor, Washington, DC, 20073, USA.
authors.forename: Fred
authors.initials: F
authors.lastname: Brody
mesh_terms: D002137:Calculi / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008297:Male; D008875:Middle Aged; D010182:Pancreatic Diseases / Q000601:surgery*; D010183:Pancreatic Ducts / Q000601:surgery*; D010193:Pancreaticojejunostomy / Q000379:methods*; D019512:Pancreatitis, Alcoholic / Q000601:surgery*