~ 71 ~ International Journal of Surgery Science 2020; 4(3): 71-76 E-ISSN: 2616-3470 P-ISSN: 2616-3462 © Surgery Science www.surgeryscience.com 2020; 4(3): 71-76 Received: 06-05-2020 Accepted: 08-06-2020 Dr. Ajay A Gujar Department of General Surgery, Amruta Surgical and Maternity Hospital, Mumbai, Maharashtra, India Dr. Amrita A Gujar K J Somaiya Hospital and Research centre, Sion, Mumbai, Maharashtra, India Dr. Aashay Dharia Dharia K J Somaiya Hospital and Research centre, Sion, Mumbai, Maharashtra, India Corresponding Author: Dr. Ajay A Gujar Department of General Surgery, Amruta Surgical and Maternity Home 408/C wing Bhaveshwar Plaza CHS LBS road, Ghatkopar West, Mumbai, Maharashtra, India Open modified puestow procedure in an advanced endoscopic era for chronic pancreatitis with dilated pancreatic duct and stones Dr. Ajay A Gujar, Dr. Amrita A Gujar and Dr. Aashay Dharia DOI: https://doi.org/ 10.33545/surgery.2020.v4.i3b.471 Abstract Background: Chronic pancreatitis has been defined as a continuing inflammatory disease of the pancreas characterized by irreversible morphological changes. These changes typically cause pain and loss of exocrine and endocrine pancreatic function. The most common symptom of chronic pancreatitis is pain, which can be severe and intractable in some patients. Although it is itself benign, chronic pancreatitis can significantly affect quality of life and can cause significant distress with its complications [1] . The initial treatment for pain in most cases is to start of enzyme replacement, control of diabetes with insulin, and administration of oral analgesics. Surgical intervention is required in patients with intractable pain that is resistant to conventional nonsurgical therapy, in patients with associated or suspected malignancy, and in patients who have developed complications such as biliary or duodenal obstruction, pancreatic fistulae, pancreatic ascites/pleural effusion, pseudocyst, or rare hemosuccus pancreaticus [2] . The aetiology of pain in chronic pancreatitis is unclear. Some evidence has suggested that perineural inflammation may be the cause of pain. A dilated pancreatic duct, secondary to obstruction, may cause increased intraductal pressures, resulting in pain [3] . The primary aim of therapy is the achievement of primary pain relief and an improvement in quality of life. This could be achieved by means of endoscopic, open or laparoscopic /robotic lateral pancreaticojejunostomy [4, 13] . Methods: We selected 41 cases of chronic pancreatitis of both genders with moderate to intractable pain hampering routine life. All patients tried conservative treatment for more than 6 months. All selected patients underwent haematological and radiological work up. MRCP of all patients showing dilated pancreatic duct more than 7mm. in size. All of these patients operated for longitudinal pancreaticojejunostomy (Modified Puestow’s). Follow up done for one year to ten years Results: All 41 patients in long term follow up were recovered well from pain and abdominal discomfort. Appetite were improved and weight gain noted in the patients after surgery. Conclusions: Longitudinal pancreaticojejunostomy is still safe, simple and timely approved procedure for pain associated with chronic pancreatitis. Keywords: Chronic pancreatitis, pancreatitis pain, partington and Rochelle pancreaticojejunostomy, modified puestow pancreaticojejunostomy Introduction Gould successfully removed calculi from the Wirsung duct in 1898 [5] . Moynihan in 1902 [6] and subsequently Mayo-Robson in 1908 [7] reported that timely removal of calculi from the pancreatic duct prevented atrophy of the pancreas and relieved pain. Coffey first performed distal pancreatectomy with pancreaticoenterostomy in dogs. He suggested that this procedure may be beneficial in various conditions [8] . Link reported the first pancreatic duct drainage operation for chronic pancreatitis in 1911. In this procedure, a catheter was placed in the pancreatic duct to drain the pancreatic juice through the skin, providing pain relief and restoring the patient’s normal weight [9] . Duval reported on distal pancreatectomy, splenectomy, and pancreaticojejunostomy in 1954 [10] . In this procedure, an end-to-end distal pancreaticojejunostomy was performed, and the pancreatic duct was decompressed in a retrograde manner. The disadvantage of this procedure was that, if the ductal system contained strictures, the entire duct would not be decompressed.