✦ PANCREAS · DRAINAGE SURGERY

Lateral Pancreaticojejunostomy (Puestow Procedure)

Q: Is the Puestow procedure effective if I am still drinking alcohol?

Complete alcohol abstinence before and after surgery is essential. Surgery relieves ductal hypertension pain, but continued alcohol accelerates fibrosis.

Q: What is the difference between Puestow and Frey procedure?

The Puestow drains the entire duct by longitudinal pancreaticojejunostomy. The Frey adds local resection of the inflammatory pancreatic head mass.

Q: Can chronic pancreatitis become cancer?

Yes — chronic pancreatitis is a risk factor for pancreatic ductal adenocarcinoma. Long-term patients require regular CT surveillance and CA 19-9 monitoring.

Surgical drainage of the dilated pancreatic duct into the jejunum — gold standard for chronic pancreatitis pain relief.

180–300 Min TREATMENT DURATION

7–10 Days CARE SETTING

Open APPROACH

6–8 Weeks RECOVERY TIMELINE

What is Lateral Pancreaticojejunostomy (Puestow Procedure)?

The Puestow procedure opens the dilated pancreatic duct longitudinally along its entire length and sutures a loop of jejunum directly to it, permanently decompressing the ductal system and relieving the intraductal hypertension that causes chronic pancreatitis pain. Dr. Tagore Mohan Grandhi performs the Puestow procedure for chronic pancreatitis with a dilated main pancreatic duct (over 7 mm). Over 80% of patients achieve durable long-term pain relief.

Suitable for patients with chronic pancreatitis and a dilated main pancreatic duct (over 7 mm) with chronic abdominal pain, particularly those who have not responded to endoscopic stenting over 12 months.

How the Procedure Works

Pre-operative Imaging

MRCP and CT confirm ductal dilation, stricture location, and dominant inflammatory head mass. Nutritional status optimised before surgery.

Pancreatic Exposure

Upper midline incision. Stomach and transverse colon retracted. Main pancreatic duct identified by needle aspiration.

Longitudinal Ductotomy

Main pancreatic duct opened along its entire length from tail to head, removing all ductal strictures under direct vision.

Pancreaticojejunostomy

Defunctioned Roux-en-Y jejunal limb sutured to the full opened duct length. Drainage permanent — no stent exchanges required.

Recovery

Oral fluids day two. Discharged in 5–7 days. Pancreatic enzyme replacement continued. Pain response assessed at 6-week follow-up.

Outcomes

180–300 MinTREATMENT DURATION

7–10 DaysCARE SETTING

OpenAPPROACH

6–8 WeeksRECOVERY TIMELINE

Who Needs This Treatment?

→Gold standard surgical drainage for dilated duct chronic pancreatitis
→80%+ of patients achieve durable long-term pain relief
→Permanent ductal decompression — no repeat procedures needed in most patients
→Preserves pancreatic endocrine and exocrine function unlike resection

The Puestow procedure gives chronic pancreatitis patients something they often thought impossible — lasting freedom from the relentless pain that has dominated their lives. The results are consistently rewarding.

— Dr. Tagore Mohan Grandhi, Senior Consultant Gastrointestinal Surgeon, Lux Hospitals, Hyderabad

Common Questions

Frequently Asked Questions

Is the Puestow procedure effective if I am still drinking alcohol?+

What is the difference between Puestow and Frey procedure?+

Can chronic pancreatitis become cancer?+

Not sure which treatment is right for you?

Book a consultation with Dr. Tagore Grandhi and get a personalised treatment plan.

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