Role of original and modified Frey's procedures in chronic pancreatitis

Abstract

AIMTo retrospectively review patients with chronic pancreatitis (CP) treated with Frey’s procedures between January 2009 and January 2014.METHODSA retrospective review was performed of patients with CP treated with Frey’s procedures between January 2009 and January 2014 in the Department of Pancreatic Surgery. A cross-sectional study of postoperative pain relief, quality of life (QoL), and alcohol and nicotine abuse was performed by clinical interview, letters and telephone interview in January 2016. QoL of patients was evaluated with the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (EORTC QLQ-C30) version 3.0. The patients were requested to fill in the questionnaires by themselves via correspondence or clinical interview.RESULTSA total of 80 patients were enrolled for analysis, including 44 who underwent the original Frey’s procedure and 36 who underwent a modified Frey’s procedure. The mean age was 46 years in the original group and 48 years in the modified group. Thirty-five male patients (80%) were in the original group and 33 (92%) in the modified group. There were no differences in the operating time, blood loss, and postoperative morbidity and mortality between the two groups. The mean follow-up was 50.3 mo in the original group and 48.7 mo in the modified group. There were no differences in endocrine and exocrine function preservation between the two groups. The original Frey’s procedure resulted in significantly better pain relief, as shown by 5-year follow-up (P = 0.032), better emotional status (P = 0.047) and fewer fatigue symptoms (P = 0.028). When stratifying these patients by the M-ANNHEIM severity index, no impact was found on pain relief after the two types of surgery.CONCLUSIONThe original Frey’s procedure is as safe as the modified procedure, but the former yields better pain relief. The severity of CP does not affect postoperative pain relief.

Bile duct preserving pancreatic head resection (BDPPHR): Can we conclusively define the extent of head resection in surgery for chronic pancreatitis?

“…Tan et al 7 conducted a retrospective review to compare the outcomes of original and modified Frey’s procedure. He concluded that original Frey’s procedure, inspite of being safe, achieved better pain relief and equal preservation of pancreatic function as compared to the modified Frey’s procedure.…”

The drain fluid amylase level on the first postoperative day predicts pancreatic fistula in chronic pancreatitis patients undergoing Frey procedure

“…In the present study, postoperative PF occurred in four out of 55 patients (7%) while three patients developed biochemical leak as per the updated ISGPF guidelines. The incidence of clinically relevant PF following Frey procedure for CP reported in various series is 5–7% 72122. Despite the low incidence of postoperative PF routine drain placement after Frey procedure is the rule among most of the surgeons.…”

Outcome of Pancreatic Head Coring in as Key Surgical Treatment in Head Dominant Chronic Pancreatitis in Tertiary Referral Centers of Bangladesh

“…The choice of surgery is determined by the extent of disease. 11 Failure of Partington-Rochelle procedure is the absence of adequate decompression of proximal MPD, uncinate process and second generation ducts 12 . In 1987, Frey and Smith described anterior resection of pancreatic head combining MPD drainage with longitudinal pancreaticojejunostomy.…”

“…6,7 Both original and modified Frey's procedure are safe, but former yields better pain relief. 11 The Duodenum-preserving pancreatic head resection (DPHR) was proposed by Beger. 20 Pancreatic malignancy is the dreadful sequel of CP with risk of progression to pancreatic adenocarcinoma 1.8% after 10 years and 4% after 20 years.…”

“…It saves pancreatic neck and preserved posterior capsule of pancreatic head along with body and tail. In both original and modified Frey's procedures, different depths of pancreatic tissue was cored 11 . Second generation ducts stones were also removed.…”