Enteric ductal drainage for chronic pancreatitis

The concept of draining an apparently obstructed main pancreatic duct was first addressed by opening either the proximal end of the pancreatic duct at the ampulla by doing a sphincterotomy or at the distal end of the pancreatic duct by removing the tail (Duval procedure). Puestow is credited with the concept of a longitudinal incision along the main pancreatic duct through the body and the head of the pancreas. This procedure was first described as a modification of a Duval procedure and therefore included resection of the pancreatic tail. Partington and Rochelle determined that a tail resection was unnecessary and carried out only a side-to-side lateral pancreaticojejunostomy. The principle of the procedure is to decompress an apparently obstructed main pancreatic duct (and maybe to also decompress the pancreatic parenchyma - the pancreatic compartment syndrome suggested by Reber). This assumption is based on the fact that the pancreatic duct is markedly dilated, suggesting a restriction to flow.