A 55-year-old man has chronic pancreatitis with a dilated main pancreatic duct (8 mm) and intractable pain not responding to endoscopic therapy. CT shows no dominant mass. The surgical procedure of choice offering pain relief while preserving pancreatic tissue is:
- A Pylorus-preserving pancreaticoduodenectomy (PPPD)
- B Distal pancreatectomy
- C Lateral pancreaticojejunostomy (Puestow-Gillesby/Partington-Rochelle procedure) ✓
- D Total pancreatectomy with islet autotransplantation
Explanation
Lateral pancreaticojejunostomy (modified Puestow — Partington-Rochelle modification) is the procedure of choice for chronic pancreatitis with a dilated MPD (≥5–6 mm, 'large duct disease') without a dominant head mass. It provides effective pain relief in 70–80% of patients by draining the obstructed duct along its length into a Roux-en-Y jejunal loop, while preserving the pancreatic head and avoiding the mortality risk of formal resection. PPPD (Beger/Frey procedure variants) is preferred when there is a dominant inflammatory head mass. Total pancreatectomy with islet autotransplantation is for refractory cases.
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.