- The patient was a 61-year-old female with periampullary stricture of the duct of Santorini and duct of Wirsung.
- Multiple pancreatic duct stents had been inserted in the duct of Santorini, but each had fallen out.
- A longitudinal pancreaticojejunostomy (Puestow procedure) was performed.
- Intraoperative ultrasound was used to locate the pancreatic duct, and splayed open to an adequate length in preparation for a side-to-side (longitudinal) pancreaticojejunostomy.
- A Roux-en-Y limb was constructed, the stapled end of the Roux limb was positioned towards the spleen, and an opening was made along its antimesenteric border.
- The longitudinal pancreaticojejunostomy was performed with two layers of anastomosis for the back and front wall.