RESULTS OF MODIFIED PUESTOW PROCEDURE IN AMELIORATION OF ABDOMINAL PAIN AND PROGRESSION OF DIABETES MELLITUS IN PATIENTS OF CHRONIC PANCREATITIS REFRACTORY TO MEDICAL THERAPY/ERCP

Abstract

The modified Puestow procedure is a ductal drainage operation used in selected patients with chronic pancreatitis and a dilated main pancreatic duct who continue to have symptoms despite medical and endoscopic treatment. This study was conducted as a secondary analysis of 10 selected patients from an IRB-approved cohort who underwent modified Puestow surgery at the Center of Excellence for Hepatobiliary Surgery, Lahore, Pakistan, between October 2019 and June 2023. Postoperative follow-up continued until June 2025. The cohort included 4 females and 6 males with severe persistent abdominal pain despite conservative treatment; 4 patients had undergone prior therapeutic ERCP without durable improvement, 1 had undergone hepaticojejunostomy, and 1 had a prior inadequate Puestow procedure. Median pain score decreased from 9 (7-10) before surgery to 1 (0-3) at last follow-up. Six patients became completely pain-free, 3 had major pain relief with only occasional mild pain, and 1 had persistent but less frequent pain. Two patients had diabetes mellitus before surgery and both remained diabetic. Among 8 non-diabetic patients, 6 remained euglycemic and 2 developed new diabetes during follow-up. There were no deaths or significant complications. Modified Puestow surgery achieved lasting palliation of pain in this nonresponsive subset, but failed to cure diabetes. Its protective effect against subsequent development of type 3c diabetes is not known.