Abstract
Objective Recurrent pancreatitis significantly impacts childhood development and quality of
life. Our goal was to evaluate the efficacy of the Puestow procedure.
Materials and Methods After obtaining the Institutional Review Board approval, we reviewed the charts of
all patients who underwent lateral pancreaticojejunostomy from January 1999 to January
2014. Statistical analysis was performed using paired Student's t-test and Fisher's exact test as appropriate.
Results During the 15-year study period, 13 patients underwent a lateral pancreaticojejunostomy
for chronic pancreatitis. The most common causes of pancreatitis were hereditary (n = 5) or obstructive (n = 5); pancreas divisum (n = 2), one iatrogenic stricture, one idiopathic stricture, and one unresectable pancreatic
head mass); two patients had idiopathic disease, and one case was drug-induced. Six
patients had failed management with endoscopic retrograde cholangiopancreatography
and pancreatic duct stenting. Preoperatively, the median body mass index (BMI) percentile-for-age
was 61.0% (range 11.0–99.0%). Median age at operation was 12.8 years (range 7.7–16.7).
There were no deaths, four patients developed postoperative ileus, and one patient
developed an intra-abdominal abscess, which resolved with antibiotics. Median postoperative
length of stay was 7 days (range 5–15).
Two patients were lost to follow-up; median follow-up for the remaining 12 patients
was 35.5 months (range 4.9–131.2). Four patients were readmitted within 90 days: three
due to abdominal pain which were not recurrences of pancreatitis, and one due to complications
of chemotherapy. Postoperatively, there was no change in the average BMI percentile-for-age
(p = 0.64). Seven patients reported resolution or significant improvement in their abdominal
pain symptoms at the time of last follow-up. Patients with obstructive causes of pancreatitis
were not more likely to experience relief than those with nonobstructive causes (42.9
vs. 80.0%, p = 0.29).
Conclusion In our experience, lateral pancreaticojejunostomy results in durable improvement
or resolution of abdominal pain symptoms in nearly 60% of patients with chronic pancreatitis
regardless of etiology.
Keywords
chronic pancreatitis - pediatrics - lateral pancreaticojejunostomy - Puestow
