A 48-year-old man with alcoholic chronic pancreatitis has intractable pain and a dilated pancreatic duct of 8 mm on MRCP. CT shows no calcification in the head and no inflammatory mass. Which surgical procedure offers best pain relief with the lowest recurrence rate?
- A Puestow procedure (lateral pancreaticojejunostomy) ✓
- B Whipple procedure (pancreaticoduodenectomy)
- C Distal pancreatectomy
- D Beger procedure (duodenum-preserving pancreatic head resection)
Correct answer: A. Puestow procedure (lateral pancreaticojejunostomy)
Explanation
For large-duct chronic pancreatitis (MPD >7–8 mm) without an inflammatory head mass, the Puestow procedure (longitudinal pancreaticojejunostomy — filleting the duct and side-to-side anastomosis to a Roux-en-Y jejunal loop) achieves excellent pain relief in >80% of cases with low morbidity. The Beger procedure (duodenum-preserving pancreatic head resection) is preferred for inflammatory pancreatic head mass. The Whipple is reserved for pancreatic head carcinoma suspicion. Distal pancreatectomy addresses tail disease.
Reference: Bailey & Love's Short Practice of Surgery, 27th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.