Puestow procedure [Case 22]

OR Footage

Summary of surgeons' findings and slowing down moments:

Dr. Gallinger’s procedure-specific moments:

1. Finding pancreatic plane: avoid splenic vein, artery; duodenojejunal flexure
2. Locate pancreatic duct, ductotomy
3. Pancreaticojejunostomy, side-to-side anastomosis

Dr. Greig’s procedure-specific moments:

1. Preserve gastroepiploic vessels
2. Obtain adequate exposure of anterior pancreas surface
3. Intraoperative ultrasound to confirm duct
4. Longitudinal ductotomy
5. Prepare adequate length of jejunum for Roux loop
6. Careful anastomosis, especially at corners
7. Close mesenteric defect

Watch the following videos from the operation to see some of the key moments in the case.