Pain relief after Frey's procedure for chronic pancreatitis

Negi, Sanjay Singh; Singh, Anurag; Chaudhary, Adarsh

doi:10.1002/bjs.7042

Cited by 61 publications

(43 citation statements)

References 30 publications

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“…The technique also proved to be easier to perform and with less morbidity than Beger's technique with similar results with regard to pain management in long follow-up 17 . The rate of postoperative complications reported in international literature varies from 0% to 42%; comprehensive national study presented by Gestic had postoperative morbidity of 28.7% 10,11,13,15,16,17,22,23 . Most of these complications are due to infectious complications, mainly pneumonia 23 .…”

Section: Pancreasmentioning

confidence: 99%

“…The operative mortality ranges from 0% to 3.2% and the causes are more often assigned is sepsis (abdominal and lung) and bleeding 10,11,13,15,16,17,22,23 . Several papers of reference centers for surgical treatment of CP reported rates of postoperative bleeding less than 3%, grouping all the techniques employed.…”

Section: Pancreasmentioning

confidence: 99%

“…Amikura and Frey 11 described excision of 5, 7 g per patient, range 2 g to 11 g, which is much lower than that reported in Brazil by Gestic 13 , with an average of 17.4 g (range 5 g to 78 g). Negi et al reported an average of 9.5 g enucleation in patients with average size of 6.0 cm pancreatic head 22 . The largest amount of excised tissue could lead to higher incidence of shortcomings but nevertheless, Gestic showed no association between the amount of pancreatic tissue excised and the emergence of new deficiencies (exocrine or endocrine) and not with the time of appearance of these 13 .…”

Section: Pancreasmentioning

confidence: 99%

“…Negi et al 22 presented results of pain control in 75% of patients at a mean follow-up of 76.8 months and demonstrated as risk factors for failure of surgical treatment, thef opiate use in the preoperative period, a pattern of ongoing pain, symptoms for at least six years, the occurrence of postoperative complications and age above 38 years. The author showed no association of relapse with the return of pain, abuse of ethanol in the postoperative period.…”

Section: Pain Controlmentioning

confidence: 99%

“…The incidence of new cases of diabetes varies in different series 10,11,13,15,16,22,23 10% to 25%, mean follow-up from 17 to 60 postoperative months. Gestic 13 following 77 months, reported incidence of new diabetes in 36.7%, above the other series.…”

Section: Pancreatic Functionmentioning

confidence: 99%

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Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual

Callejas-Neto¹,

Chaim²,

Gestic³

et al. 2011

ABCD, arq. bras. cir. dig.

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-Introduction -Chronic pancreatitis is a progressive inflammatory disorder characterized by irreversible destruction of pancreatic parenchyma and may be associated with disabling chronic pain and permanent loss of endocrine and exocrine function. Main indication for surgery is intractable abdominal pain and choosing the best technique to be used for a patient remains a challenge. The technique described by Frey combines the effectiveness of pain control characteristic of resection surgery with low mortality and morbidity of derivative procedures. Aim -To compare and discuss the results of surgical treatment of chronic pancreatitis with Frey procedure. Methods -A literature review of scientific articles available in Medline/Pubmed database and the national theses descriptors with terms chronic pancreatitis, surgical treatment and Frey procedure. It was selected the most important articles and that reported more experience with this surgical option. Conclusions -Frey procedure proves to be an option with high effectiveness in controlling abdominal pain secondary to chronic pancreatitis in the long term in patients with abdominal pain and enlarged pancreatic head, with lower rates of morbidity and mortality. The studies showed little interference of technique in the deterioration of endocrine and exocrine pancreatic functions. ABCDDV/817RESUMO -Introdução -A pancreatite crônica é desordem inflamatória progressiva caracterizada pela destruição irreversível do parênquima pancreático, podendo estar associada à dor crônica incapacitante e perda permanente da função endócrina e exócrina. A principal indicação cirúrgica é a dor abdominal intratável e a escolha da melhor técnica a ser empregada permanece um desafio. A técnica descrita por Frey conseguiu combinar a eficácia no controle da dor das operações de ressecção com as baixas taxas de mortalidade e morbidade das derivativas. Objetivo -Comparar e discutir os resultados do tratamento cirúrgico da pancreatite crônica com a técnica de Frey. Métodos -Revisão bibliográfica de 276 artigos científicos disponíveis no Medline/ Pubmed e no banco de dados de teses nacionais com os descritores pancreatite crônica, tratamento cirúrgico e cirurgia de Frey. Foram selecionados os 30 artigos de maior importância e que relataram maior experiência com esta opção cirúrgica. Conclusões -A técnica de Frey demonstra ser opção de alta efetividade no controle da dor abdominal secundária à pancreatite crônica no longo prazo naqueles pacientes com dor abdominal incapacitante e aumento volumétrico da cabeça pancreática, com menores taxas de morbidade e mortalidade. Os estudos demonstraram pequena interferência da técnica na deterioração das funções endócrina e exócrina.

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Section: Pancreasmentioning

confidence: 99%

Section: Pancreasmentioning

confidence: 99%

Section: Pancreasmentioning

confidence: 99%

Section: Pain Controlmentioning

confidence: 99%

Section: Pancreatic Functionmentioning

confidence: 99%

See 3 more Smart Citations

Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual

Callejas-Neto¹,

Chaim²,

Gestic³

et al. 2011

ABCD, arq. bras. cir. dig.

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The Frey Procedure for Chronic Pancreatitis Secondary to Pancreas Divisum

et al. 2013

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In this series, outcomes for patients with CPPD treated with the Frey procedure were equivalent to those treated for CPA. Patients with pancreas divisum and a dilated pancreatic duct may be ideally suited for this surgical strategy. The potential advantage of this approach over minor duct sphincteroplasty and lateral pancreaticojejunostomy is the removal of the fibrotic tissue of the head of the pancreas, thought to be the epicenter of pain in this condition. The benefits over resection alone include a more extensive ductal drainage procedure.

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Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis

van Veldhuisen,

Kempeneers,

de Rijk

et al. 2024

JAMA Surg

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ImportancePatients with painful chronic pancreatitis and a dilated pancreatic duct can be treated by early surgery or an endoscopy-first approach.ObjectiveTo compare long-term clinical outcomes of early surgery vs an endoscopy-first approach using follow-up data from the ESCAPE randomized clinical trial.Design, Setting, and ParticipantsBetween April 2011 and September 2018, 88 patients with painful chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach in 30 hospitals in the Netherlands collaborating in the Dutch Pancreatitis Study Group as part of the ESCAPE randomized clinical trial. For the present cohort study, long-term clinical data were collected after the initial 18-month follow-up. Follow-up was completed in June 2022, and data analysis was performed in June 2023.ExposurePatients with chronic pancreatitis were randomly assigned to early surgery or an endoscopy-first approach.Main Outcomes and MeasuresThe primary end point was pain, assessed by the Izbicki pain score; secondary end points included patient-reported complete pain relief and satisfaction. Predefined subgroups included patients who progressed from endoscopy to surgery and those with ductal clearance obtained by endoscopy. Analysis was performed according to the intention-to-treat principle.ResultsIn this cohort study, 86 of 88 overall patients could be evaluated, with a mean (SD) follow-up period of 98 (16) months. Of 88 initial patients, 21 patients (24%) were female, and mean (SD) patient age was 61 (10) years. At the end of long-term follow-up, the mean (SD) Izbicki pain score was significant lower (33 [31] vs 51 [31]) in the early surgery group, as was the rate of patient-reported complete pain relief (14 of 31 patients [45%] vs 6 of 30 patients [20%]), compared to the endoscopy-first group. After the initial 18-month follow-up, 11 of 43 patients in the early surgery group (26%) underwent reinterventions vs 19 of 43 patients in the endoscopy-first group (44%). At the end of follow-up, more patients in the early surgery group were “very satisfied” with their treatment (22 of 31 patients [71%] vs 10 of 30 patients [33%]). Patients who progressed from endoscopy to surgery (22 of 43 patients [51%]) had significantly worse mean (SD) Izbicki pain scores (33 [31] vs 52 [24]) compared to the early surgery group and had a lower rate of complete pain relief (55% for early surgery vs 12% for endoscopy first). In the endoscopy-first group, patients with endoscopic ductal clearance had similar mean (SD) Izbicki pain scores as the remaining patients (49 [34] vs 53 [28]).Conclusions and RelevanceIn this cohort study evaluating long-term outcomes of the ESCAPE randomized clinical trial, after approximately 8 years of follow-up, early surgery was superior to an endoscopy-first approach in patients with painful chronic pancreatitis and a dilated main pancreatic duct in pain scores and patient satisfaction. Notably, patients who progressed from endoscopy to surgery had worse outcomes compared to patients undergoing early surgery, and obtaining endoscopic ductal clearance did not improve outcomes.

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Pain relief after Frey's procedure for chronic pancreatitis

Abstract: Frey's procedure leads to significant and sustained long-term pain relief in patients with chronic pancreatitis. Patients should be referred for surgery before opiates are needed to relieve pain.

Cited by 61 publications

References 30 publications

Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual

Tratamento cirúrgico da pancreatite crônica com a técnica de F rey: panorama atual

The Frey Procedure for Chronic Pancreatitis Secondary to Pancreas Divisum

Long-Term Outcomes of Early Surgery vs Endoscopy First in Chronic Pancreatitis

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