The Puestow

[Guest guest]

Paget,

You asked about the Puestow & about Dr. Lehman doing the surgery. Actually,

none of the ERCP doctors do this procedure, as it is a surgery which requires

general anesthesia and an abdominal incision. I think very highly of Dr.

, who is a pancreatic surgeon at Indiana University Hospital.

You asked about the procedure, also. What is essentially happening is the

pancreatic duct is being made wider. Imagine taking two pant's legs and cutting

them down the sides, then sewing the two legs together to make one large leg,

or tube skirt. That is what is done here, except one of the pant's legs is the

pancreatic duct and the other is the jejunum, a part of the small intestine.

The larger duct allows the pancreas to drain much more easily. The pancreas

originally drains into the duodenum, now it would be draining into the jejunum,

the next part of the intestine right below the duodenum.

The food consumed still goes from the stomach into the duodenum segment of

the small intestine. The only difference is that the pancreatic enzymes and bile

will come in contact with the food when the duct drains into the jejunum.

(FYI only)

The intestine is long and is broken down into different names. The stomach

releases food into the duodenum, which is the first part of the small intestine.

The other two parts are the jejunum and the ileum. The small intestine is

largely responsible for the breakdown of food and absorption of nutrients. The

large intestine is just a continuation of the small intestine and consists of

the cecum and ascending (right) colon, the transverse colon, the descending

(left) colon, and the sigmoid colon, which is connected to the rectum. The large

intestine secretes mucus and is largely responsible for the absorption of water

from the stool.

You voiced concern about the effect it would have on the organ and duct. The

pancreas remains intact, including the head and tail. All pancreatic function

remains unchanged, as none of the gland has been removed. The duct has not

been stretched, either, it simply has had an additional piece of panel sewn onto

it, so it would not have to undergo the type of stretching that is done with

stents.

This is only successful on a long term basis if the only problem originates

and resides within the duct. Otherwise, it is only a temporary procedure.

It is really impossible to completely visualize how this works without a

seeing a picture, but it may give you an idea of the principle of the surgery.

Karyn E. , RN,

Exec. Director, PAI

*http://www.pancassociation.org