A patient with chronic calcific pancreatitis and a dilated main pancreatic duct (>7 mm) has intractable pain despite medical treatment. Which surgical procedure, by creating a side-to-side pancreaticojejunostomy, provides the best long-term pain relief?

• A Beger procedure (duodenum-preserving pancreatic head resection)
• B Frey procedure (local resection of pancreatic head with lateral pancreaticojejunostomy)
• C Puestow procedure (lateral pancreaticojejunostomy) ✓
• D Whipple procedure (pancreaticoduodenectomy)

Explanation

The Puestow procedure (modified longitudinal pancreaticojejunostomy, Partington-Rochelle modification) creates a side-to-side anastomosis between the widely opened dilated pancreatic duct and a Roux-en-Y jejunal loop, effectively decompressing the obstructed duct. It is indicated when the main pancreatic duct is dilated (chain-of-lakes appearance) and is the classic drainage procedure. The Frey procedure adds partial head resection for those with inflammatory head enlargement. The Beger procedure is reserved for dominant head disease. The Whipple is used for malignancy or failed drainage procedures.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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Written and medically reviewed by the StethoPrep medical team.