Frey Procedure Combined with Biliary Diversion for the Treatment of Chronic Pancreatitis‐Related Biliary Obstruction: Impact of the Types of Diversion

Abstract

Background Frey procedure (FP) has become the standard of treatment for patients with painful chronic pancreatitis and inflammatory head mass. Biliary diversion (BD) is necessary when there is persistent biliary obstruction after adequate head coring. The aim of the present study was to assess the impact of types of biliary diversion on short‐term outcome and rates of stricture recurrence. Methods All the patients, who underwent FP combined with BD between August 2007 and July 2017 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India, were retrospectively reviewed. The types of BD performed were choledochojejunostomy (Group A) or opening of the CBD in the resection cavity (Group B). Results During the study period, 36 patients underwent FP with BD. Choledochojejunostomy was performed in 21 patients and opening of the CBD in the resection cavity in 15 patients. Preoperative characteristics and early surgical outcomes were comparable except the postoperative stay which was longer in those who underwent choledochojejunostomy (p = 0.044). Pain control was similar. Over a median follow‐up of 72 months, five patients in the Group B developed stricture recurrence which was significantly higher than those of Group A (p = 0.008). Conclusion Choledochojejunostomy combined with FP achieves efficient BD with a lower rate of restricture compared with opening of the CBD in the resection cavity.

Surgical Procedures for Biliary Stricture in Chronic Pancreatitis

“…Decompression of the intrapancreatic part of the choledoch by excision of the inflammatory mass was sufficient for 28 (90.3%) of 31 patients for contrast to enter the duodenum, no signs of recurrence of BS in these patients were observed. Therefore, we support the methodology and conclusions of Merdrignac et al, And Ray, S et al [23,24] who published a similar approach.…”

“…Each of these methods has its advantages and disadvantages, the ratio of which varies between studies. For example, some authors consider hepaticocholedoenterostomy (GEA / HEA) to be the "gold standard" [22][23][24], while others consider it sufficient to perform choledochoduodenoanastomosis (CDS) [25] or transduodenal papillosphincteroplasty (TDPST) that are regarded as a potential cause of recurrent cholangitis and a potential risk factor for cholangiocarcinoma [26]. The fenestration of the choledochus into the resection cavity is widely known, but some recent studies have shown a high recurrence rate of biliary obstruction with this technique [23].…”

“…For example, some authors consider hepaticocholedoenterostomy (GEA / HEA) to be the "gold standard" [22][23][24], while others consider it sufficient to perform choledochoduodenoanastomosis (CDS) [25] or transduodenal papillosphincteroplasty (TDPST) that are regarded as a potential cause of recurrent cholangitis and a potential risk factor for cholangiocarcinoma [26]. The fenestration of the choledochus into the resection cavity is widely known, but some recent studies have shown a high recurrence rate of biliary obstruction with this technique [23]. Therefore, in addition to determining the benefits of surgical treatment of BS, it should be established whether all techniques will be accompanied by such benefits equally.…”

“…Therefore, in addition to determining the benefits of surgical treatment of BS, it should be established whether all techniques will be accompanied by such benefits equally. One of the rational proposed combinations [23,24] is Frey's procedure and, if necessary, BDA.…”

Frey procedure for chronic pancreatitis: A narrative review

“…It allowed both bile and pancreatic secretion to drain in the Roux-en-Y jejunal limb used for pancreaticojejunostomy. This group of patients may develop biliary stricture later on and needs long-term follow-up [ 28 ].…”