Pancreaticojejunostomy

The Puestow procedure has a reported mortality rate of 4%, and a complication rate between 10-15% (27-33). Because pancreatic parenchyma is preserved, endocrine and exocrine insufficiency is not exacerbated. Despite the fact that a longitudinal pancreaticojejunostomy is a safe procedure, long-term mortality remains high with a 5-yr survival as low as 40%. This is attributed to continued alcoholism, and comorbid conditions. Recurrent inflammatory changes occur in 15-20% of patients, as a result of obstruction and persistent disease in the pancreatic head.

Frey Pancreaticojejunostomy
Fig. 7. Puestow procedure. (A) Opening of pancreatic duct. (B) Anastomosis of pancreatic duct to jejunal limd. (C) Roux-en-Y pancreaticojejunostomy.

Longitudinal Pancreaticojejunostomy with Excavation of the Pancreatic Head (Frey Procedure)

As the pancreatic duct dives posteriorly into the head of the gland, adequate decompression with a longitudinal pancreaticojejunostomy alone is difficult. The Frey procedure, with excavation of the proximal gland, is used especially in cases where the pancreatic head is enlarged as seen in most cases of chronic pancreatitis.

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