Longitudinal pancreaticogastrostomy in patients with chronic pancreatitis

The Partington–Rochelle (P–R) or Puestow procedure1 is one of the most commonly performed drainage procedures for chronic pancreatitis and can be achieved with low rates of morbidity and mortality to obtain good relief of chronic abdominal pain.2 Frey and Smith3 combined this with duodenal-preserving limited pancreatic head resection (LHR) and drainage of the resection cavity (in patients in whom pancreatic head enlargement predominated) with similar outcomes.4 The current article presents a new modification of the classical P–R and LHR procedures in which the Roux-en-Y pancreaticojejunostomy has been eliminated, and the dilated pancreatic duct or the locally excised head of the pancreas is covered with a longitudinally opened segment of the stomach. The laparoscopic technique for the modified P–R procedure and the side-to-side procedure to obtain gastric drainage of the pancreatic remnant after pancreaticoduodenectomy are both described.