The Puestow Procedure in Chronic Pancreatitis: A Narrative Review

Chronic pancreatitis is a progressive inflammatory disease characterized by persistent abdominal pain, exocrine and endocrine insufficiency, and impaired quality of life. Although medical and endoscopic therapies may provide symptom control in selected patients, surgery remains a cornerstone in those with refractory pain and structural ductal disease. The Puestow procedure, also known as lateral pancreaticojejunostomy (LPJ), is a well-established surgical option for patients with chronic pancreatitis and a dilated main pancreatic duct. This narrative review summarizes the indications, technical principles, outcomes, complications, and evolving minimally invasive approaches of the Puestow procedure, based on current literature. Emphasis is placed on patient selection and the role of LPJ within modern multidisciplinary management strategies for chronic pancreatitis.