Longitudinal Pancreaticojejunostomy (Puestow)
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Procedure Description
Longitudinal Pancreaticojejunostomy, commonly referred to as the Puestow procedure, is a surgical technique used to treat chronic pancreatitis, particularly when caused by a dilated pancreatic duct. This surgery is designed to relieve chronic pain and improve pancreatic function by creating a direct connection between the pancreatic duct and the jejunum (a part of the small intestine), allowing for better drainage of pancreatic fluids.
During the procedure, an incision is made in the abdomen to expose the pancreas and the small intestine. The surgeon carefully opens the pancreatic duct longitudinally, extending from the head to the tail of the pancreas. The jejunum is then brought up and attached to the opened duct to form a continuous channel for drainage. This bypasses the obstruction and reduces pressure in the duct, mitigating pain and preventing further damage.
The Puestow procedure is typically reserved for patients who have not responded to conservative treatments such as medications or endoscopic stenting. It is considered highly effective for those with significant ductal dilation due to chronic pancreatitis. While it does not cure the underlying cause of pancreatitis, it helps manage symptoms and improve the quality of life.
Procedure Duration
The entire procedure usually takes about 3-5 hours, depending on the complexity and the patient’s specific condition. It begins with preoperative preparations that include imaging studies such as MRI or CT scans to map the pancreas and evaluate the extent of ductal dilation. General anesthesia is administered to ensure the patient remains unconscious and pain-free throughout the operation.
After the initial incision, the surgeon carefully dissects the tissues to reach the pancreas. The precise alignment and suturing of the pancreatic duct to the jejunum are crucial to the success of the surgery, requiring meticulous attention. The duration may extend if there are complications or if additional procedures are necessary to address other pancreatic or gastrointestinal issues.
Post-surgery, the patient is monitored in a recovery room and may need to stay in the hospital for 5-7 days. This period is critical to manage pain, monitor for potential complications like infections or leaks, and ensure that the drainage channel is functioning properly. Full recovery and the resumption of normal activities can take several weeks, with dietary adjustments and regular follow-ups being key components of the healing process.
Benefits
- Pain Relief: Significant reduction in chronic abdominal pain, leading to improved daily functioning.
- Improved Pancreatic Function: Helps maintain enzyme flow, aiding digestion and nutrient absorption.
- Prevention of Further Damage: Reduces the risk of ongoing inflammation and tissue scarring.
- Enhanced Quality of Life: Allows patients to resume more regular activities and reduces the need for ongoing medication.
- Minimized Hospital Visits: Decreases the frequency of emergency visits due to severe pancreatitis flare-ups.
Potential Destinations
1. India
India has become a prominent destination for pancreatic surgery due to its combination of experienced surgeons, advanced medical technology, and cost-effective care. Hospitals are known for adhering to international standards, making India an appealing choice for medical tourists.
2. Thailand
Thailand offers state-of-the-art medical facilities and highly skilled surgical teams specializing in gastrointestinal surgeries. Medical tourism is well-established, and patients benefit from comprehensive care packages that include surgery, recovery, and accommodation.
3. Turkey
With its strategic location and reputable healthcare system, Turkey has become a hub for high-quality, affordable medical procedures. Many hospitals in Turkey are internationally accredited and have specialized departments for treating complex pancreatic conditions.
4. Mexico
For patients seeking quality care closer to the U.S., Mexico is an excellent option. The country boasts experienced surgeons and hospitals equipped with modern medical infrastructure. Medical tourism facilitators often provide tailored packages to streamline the patient experience.
5. Spain
Spain’s healthcare system is renowned for its excellence, and the country offers access to specialists in pancreatic surgery. The blend of cutting-edge medical technology and patient-focused care makes Spain a preferred choice for many medical tourists.
Risks & Considerations
- Infection Risk: Postoperative infections can occur at the surgical site or internally.
- Bleeding: Excessive blood loss during or after surgery may require further intervention.
- Leakage: There is a risk of leakage from the connection between the pancreatic duct and the jejunum, which may necessitate additional procedures.
- Delayed Gastric Emptying: Some patients may experience slow stomach emptying, leading to nausea and discomfort.
- Diabetes: The surgery can impact the endocrine function of the pancreas, potentially leading to or exacerbating diabetes.
How to Choose the Right Doctor and Hospital
Selecting the right healthcare provider for a complex procedure like Longitudinal Pancreaticojejunostomy is essential. Patients should look for surgeons who specialize in pancreatic surgeries and have a high success rate. Board certification and experience in performing Puestow procedures are vital indicators of expertise.
It is equally important to choose a hospital known for its specialized gastroenterology and hepatobiliary departments, equipped with the latest surgical technology. Patients should also review patient testimonials and success stories, while considering facilities that provide robust post-operative care and support.
To receive a free quote for this procedure please click on the link: https://www.medicaltourism.com/get-a-quote
Patients are advised to seek hospitals that are accredited by Global Healthcare and only work with medical tourism facilitators who are certified by Global Healthcare Accreditation or who have undergone certification from the Certified Medical Travel Professionals (CMTP). This ensures that the highest standards in the industry are met. GHA accredits the top hospitals in the world. These are the best hospitals in the world for quality and providing the best patient experience. Click the link to check out hospitals accredited by the Global Healthcare Accreditation: https://www.globalhealthcareaccreditation.com
Frequently Asked Questions
What actually happens during hyperstimulation of the ovaries?
The patient will take injectable FSH (follicle stimulating hormone) for eight to eleven days, depending on how long the follicles take to mature. This hormone is produced naturally in a woman’s body causing one egg to develop per cycle. Taking the injectable FSH causes several follicles to develop at once, at approximately the same rate. The development is monitored with vaginal ultrasounds and following the patient’s levels of estradiol and progesterone. FSH brand names include Repronex, Follistim, Menopur, Gonal-F and Bravelle. The patient injects herself daily.
What happens during egg retrieval?
When the follicles have developed enough to be harvested, the patient attends an appointment where she is anesthetized and prepared for the procedure. Next, the doctor uses an ultrasound probe to guide a needle through the vaginal wall and into the follicle of the ovary. The thin needle draws the follicle fluid, which is then examined by an embryologist to find the eggs. The whole process takes about 20 minutes.
What happens to the eggs?
In the next step, the harvested eggs are then fertilized. If the sperm from the potential father, or in some cases, anonymous donor, has normal functionality, the eggs and sperm are placed together in a dish with a nutrient fluid, then incubated overnight to fertilize normally. If the sperm functionality is suboptimal, an embryologist uses Intracytoplasmic Sperm Injection to inject a single sperm into a single egg with an extremely precise glass needle. Once fertilization is complete, the embryos are assessed and prepared to be transferred to the patient’s uterus.
How are the embryos transferred back to the uterus?
The doctor and the patient will discuss the number of embryos to be transferred. The number of successfully fertilized eggs usually determines the number of eggs to be placed in the uterus. Embryos are transferred to the uterus with transabdominal ultrasound guidance. This process does not require anesthesia, but it can cause minor cervical or uterine discomfort. Following transfer, the patient is advised to take at least one days bed rest and two or three additional days of rest, then 10 to 12 days later, two pregnancy tests are scheduled to confirm success. Once two positive tests are completed, an obstetrical ultrasound is ordered to show the sac, fetal pole, yolk sac and fetal heart rate.
Embryoscope©
Built into this technology there is a microscope with a powerful camera that allows the uninterrupted monitoring of the embryo during its first hours of life. In this way, we can keep a close eye on the embryo, from the moment when the oocyte is inseminated and begins to divide into smaller and smaller cells, until it can be transferred to the uterus.
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