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Fig. 2A —Puestow procedure. Diagram of anatomy after modified Puestow procedure. The pancreas is filleted to expose main duct from neck to tail, and ductal calculi are removed. Roux loop of jejunum is anastomosed to "capsule" of pancreas with direct drainage of main and secondary pancreatic ducts into lumen of jejunum over 8-10 cm segment. This procedure is best performed if main pancreatic duct is significantly (>6 mm) dilated. (Used with permission of Visual Media, Indianapolis, IN)