“OUTCOME OF FREY'S PROCEDURE FOR CHRONIC PANCREATITIS”

Abstract

Background:- Chronic pancreatitis is (CP) is a progressive inammatory disease of the pancreas associated with disabling abdominal pain and gradual deterioration of exocrine and endocrine function. Up to 50% of patients with CP may require surgery during the course of the disease. The main indication for surgery is intractable abdominal pain not amenable to medical and endoscopic therapy. The type of surgery depends on pancreatic ductal diameter and associated parenchymal pathology like inammatory head mass. Frey procedure (FP) is an effective method for control of pain in patients with enlarged pancreatic head. FP can be performed with a very low mortality and an acceptable morbidity. Compared with pancreaticoduodenectomy (PD), FP has favourable outcomes in terms of operation time, blood loss, morbidity, post-operative hospital stay, intensive care unit stay, and quality of life. FP has shorter operation time and lower morbidity in comparison to Beger procedure. But, long-term pain control and exocrine and endocrine dysfunctions are comparable between PD, Beger and FP. FP is technically easier than PD and Beger procedure. FP is thus a widely acceptable procedure for CP with enlarged pancreatic head in absence of a neoplasia. Methods: Prospective observational study conducted in R. D. GARDI MEDICAL COLEGE UJJAIN (M.P.) 1AUGUST 2018 TO 1 AUGUST 2019. The diagnosis of chronic pancreatitis was based on the ndings of clinical history, physical examination and radiological investigation. Radiological investigation consisted of a combination of ultrasonography (US), computed tomography (CT) and MRCP.Surgically treated cases of Chronic Pancreatitis who underwent Frey's procedure and had minimum 3 months and maximum 12 months of follow up were included in the study A total number of 17 patients were studied in one year. Post-operatively all patients were a Results: sked to classify their pain as mild, moderate and severe or no pain. Patients were also asked to repeat endocrine and exocrine function tests. Only patients with at least 12 months of post-operative follow-up were included. At the time of the last follow-up visit, 91%(n = 15) of patients described complete pain relief, 7% (n = 2) described occasional episodic pain but did not take analgesics routinely. Only one patient had pain recurrence 1year after surgery; he had been abusing alcohol and drugs. Conclusions- The results of the study conrmed that local resection of the head with longitudinal pancreatojejunostomy as proposed by Frey has high effectiveness in the treatment of pain in long-term follow-up, combined with little interference in the disease course (endocrine and exocrine function).Frey's procedure should be considered as the primary operation in patients with disabling pain as a result of CP because it is safer, easier and presents less morbidity and mortality than alternative techniques.