Surgical Success in XXXX : Sequential Endoscopic Retrograde Cholangiopancreatography and Surgical Longitudinal Pancreatojejunostomy (Puestow Procedure).

@entity1 @entity227 @entity788 @entity6 @entity254 @entity1689 @entity4306 @entity490 @entity158
Introduction   @entity1689 ( @entity1689 ) can be a cause of recurrent, severe, disabling @entity490 in @entity1 . Surgery has been suggested as a useful therapy, although experience is limited and the results unpredictable. We reviewed our experience of a two-stage protocol-preliminary endoscopic retrograde cholangiopancreatography (ERCP) and duct stenting, and if symptoms resolved, definitive surgical decompression by longitudinal pancreatojejunostomy (LPJ) (Puestow operation). @entity1 and Methods   This is a single-center, retrospective review of @entity1 with established @entity1689 who underwent an LPJ between February 2002 and September 2012. A questionnaire was completed (incorporating @entity227 and lifestyle scores) to assess functional outcome. Data are expressed as median (range). Results   In this study, eight (M:F ratio of 4:4) @entity1 underwent an LPJ and one female @entity1 had a more limited pancreatojejunostomy @entity254 following preliminary ERCP and stent placement where possible. Diagnoses included @entity4306 (n   =   3), idiopathic or structural @entity788 (n   =   5), and duct stricture following radiotherapy (n   =   1). Median duct diameter presurgery was 5 (4-11) mm. Endoscopic placement of a Zimmon pancreatic stent was possible in six with relief of symptoms in all. Median age at definitive surgery was 11 (range, 7-17) years with a median postoperative stay of 9 (range, 7-12) days and a follow-up of 6 (range, 0.5-12) years. All @entity1 reported markedly reduced episodes of @entity158 postprocedure. One developed @entity6 , while three had exocrine deficiency (fecal elastase   <   200   g/g) requiring enzyme supplementation. The @entity1 with limited LPJ had symptomatic recurrence and required restenting and further surgery to widen the @entity254 to become @entity158 free. Conclusion   ERCP and stenting provide a therapeutic trial to assess possible benefit of a definitive duct drainage procedure. LPJ-the modified Puestow operation was safe and complication-free with good medium-term relief of symptoms. We were not able to identify a consistent etiology-associated outcome.
