A dominant component of chronic pancreatitis is the pancreatic duct hypertension, caused by fibrotic replacement of normal pancreatic tissue. Duct stenosis and hypertension are the basis of the duct pressure-pain hypothesis. Drainage operations are performed on the assumption that pain relief is obtained by drainage of the main pancreatic duct.

Longitudinal decompression of the main pancreatic duct (at the level of the body-tail) was proposed in the ’50s by Puestow and modified in 1960 by Partington and Rochelle (latero-lateral Wirsung-jejunostomy) became the first surgical treatment widely considered to be effective for pain in chronic pancreatitis. Briefly, after accessing the lesser sac, a ventral incision of the main pancreatic duct is made until the head of the pancreas, at the level of gastroduodenal artery. The Wirsung duct is then anastomosed with a Roux-en-Y loop. Only patients with dilated pancreatic duct are amenable of lateral pancreatico-jejunostomy. According to the current literature, the immediate success rate is about 80%, but 30% experience pain recurrence after 3-5 years, probably because of concomitant inflammatory mass in the head of the pancreas.

Izbicki et al. proposed a technical modification (pancreatic longitudinal excavation and lateral pancreatico-jejunostomy) to treat patients with small, non-dilated main pancreatic duct (< 5 mm).

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Andersen DK, Frey CJ. Ann Surg. 2010;251:18-32.