Frey Procedure For Chronic Pancreatitis Research Articles

Feasibility of laparoscopic modified Frey procedure for chronic pancreatitis: a prospective 6 case series.

Chronic pancreatitis (CP) is characterized by longstanding inflammation of the pancreas. Several authors have reported minimally invasive treatment of this CP (pancreaticoduodenectomy, lateral pancreaticojejunostomy, Frey procedure) with promising short-term outcomes. This is a case series of 6 patients diagnosed with CP and treated using the laparoscopic modified Frey procedure at Hue Central Hospital, Vietnam. Six patients (5 males and 1 female) with CP and operated on using modified Frey's procedure. The median age was 45 years old. The mean of Body Mass Index was 16.3 kg/m2. The median preoperative duration of symptoms was 3.3 years. All patients were presented with a dilated main pancreatic duct (mean diameter of 7.8 mm). The median time to first bowel movement was 1.5 (1-2) days. The median postoperative hospital stay was 7 (5-11) days. No reoperation or mortality was recorded. The laparoscopic modified Frey procedure is feasible and safe with good short-term and mid-term outcomes for chronic pancreatitis.

Outcome of Frey procedure for Chronic Pancreatitis: A Single Centre Experience

Outcome of Frey procedure for Chronic Pancreatitis: A Single Centre Experience

Surgical outcomes of the Frey procedure for chronic pancreatitis: correlation between preoperative characteristics and the histological severity of pancreatic fibrosis.

To evaluate the efficacy of the Frey procedure and clarify the relationship between preoperative characteristics and thehistological severity of chronic pancreatitis (CP). Thirty patients who underwent the Frey procedure for CP between January, 2002 and December, 2020, at our hospital, were enrolled in this study. The specimen cored out of the pancreatic head was assessed for CP severity. We evaluated preoperative status and surgical outcomes according to CP severity. Long-term pain relief was achieved in all 26 patients with sustained long-term follow-up, with complete pain relief attained in 19 (63%). Albumin levels were significantly higher 1year postoperatively than preoperatively (p = 0.038). Histological fibrosis was assessed in the 26 patients as follows: normal (n = 4; 15%), mild (n = 8; 31%), moderate (n = 2; 8%), and severe (n = 12; 46%). These patients were divided into two groups according to the severity of fibrosis: normal/mild (n = 12) and moderate/severe (n = 14). The rates of diffuse calcification on preoperative computed tomography (CT) (71% vs. 17%, p = 0.008) and islet atrophy on insulin immunohistochemistry (100% vs. 33%, p < 0.001) were significantly higher in the moderate/severe group than in the normal/mild group. The Frey procedure can achieve good pain relief and improve nutritional status. The severity of fibrosis can be predicted based on the extent of calcification on preoperative imaging studies.

Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis

BackgroundThe literature on predictors for postoperative complications after Frey procedure (FP) is sparse. The aim of this study is to report our experience with 90-day complications of FP and predictors for complications. MethodsAll patients with chronic pancreatitis (CP), who underwent a FP between August 2007 and July 2021, were retrospectively reviewed. Univariate and multivariate analysis were used to identify predictors of 90-day morbidity and mortality. ResultsOf the total 270 patients, 84 (31%) patients developed at least one postoperative complication. Major complications occurred in 32 (12%) patients. Most common complication was wound infection and it was significantly more common in stented patients (p = 0.017). Pancreatic fistula and post pancreatectomy hemorrhage (PPH) developed in 7.4% of patients. Thirteen patients (4.8%) required early re-operation and the most common cause of re-exploration was PPH. 90-day mortality was 1% (n = 3) and all 3 patients required re-exploration for PPH. Median postoperative hospital stay was 9 (5–51) days. Perioperative blood transfusions was the only independent predictor of postoperative complications after FP. ConclusionsFrey procedure is an acceptable treatment modality with low rates of mortality and reasonable perioperative morbidities. Minimizing blood transfusions may further improve 90-day outcomes.

Short- and long-term outcome of Frey procedure for chronic pancreatitis in adults

ObjectiveTo report our experience with Frey procedure (FP) for chronic pancreatitis (CP) in adults. MethodsAdult patients with CP, who underwent a FP between August 2007 and July 2018, were retrospectively reviewed. ResultsOf the total 138 patients, 95 (69%) were male. The median age at operation was 36.5 years. The median pain-surgery interval was 48 months. Alcohol abuse was identified in 64 (46%) patients. The major indication for surgery was disabling pain (94%). There was no postoperative mortality. Postoperative complications developed in 43 (31%) patients. Median postoperative hospital stay was 9 days. Over a median follow-up of 65 months, 84% of patients had complete pain relief. Continuous pain and high preoperative Izbicki pain score were associated with incomplete pain control. New-onset diabetes and exocrine insufficiency developed in 31% and 27% of patients respectively. Longer duration of disease and previous pancreatic surgery were associated with the development of new-onset diabetes after the FP. ConclusionsFrey procedure is safe with an acceptable perioperative complications and good long-term pain control.

Long-term outcomes following the frey procedure for chronic pancreatitis in a select group of north american patients

Long-term outcomes following the frey procedure for chronic pancreatitis in a select group of north american patients

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

Backgrounds/AimsAbdominal drains are routinely placed following Frey procedure for chronic pancreatitis (CP) despite the low incidence of pancreatic fistula (PF). The utility of the first postoperative day (POD1) drain fluid amylase (DFA) value in predicting PF in CP patients undergoing Frey procedure has not been previously reported.MethodsA prospective study of patients with CP who underwent Frey procedure between August 2014 and April 2018. A standard technique of head coring with single layer continuous pancreatojejunostomy was done in all the patients. Amylase level of the drain placed close to the pancreatojejunostomy was recorded on POD1 and 3. Postoperative PF was defined and graded as per the updated International Study Group of Pancreatic Fistula (ISGPF) guidelines.ResultsFifty-five patients with CP who fulfilled the inclusion criteria were included in the study. All had normal preoperative serum amylase level. Three patients developed a biochemical leak and four patients developed postoperative PF (Grade B - 3 and Grade C - 1). Receiver operating characteristics (ROC) curve identified a POD1 DFA cut-off value of 326 U/L that predicted a postoperative PF with sensitivity, specificity and negative predictive value of 100%, 70%, and 100% respectively.ConclusionsThe POD1 DFA is a reliable predictor of postoperative PF in CP patients who have undergone Frey procedure. The PF can be confidently excluded in patients who have a POD1 DFA less than 326 U/L.

Does radicality of Frey procedure for chronic pancreatitis influence the late re-intervention rate after surgery?

Does radicality of Frey procedure for chronic pancreatitis influence the late re-intervention rate after surgery?

Does radicality of frey procedure for chronic pancreatitis influence the late re-intervention rate after surgery?

Does radicality of frey procedure for chronic pancreatitis influence the late re-intervention rate after surgery?

Short- and long-term outcomes of the Frey procedure for chronic pancreatitis: a single-center experience and summary of outcomes in Japan.

To evaluate the short- and long-term outcomes of the Frey procedure for chronic pancreatitis (CP). The subjects of this study were 12 patients who underwent the Frey procedure for CP between January, 2000 and December, 2016. We assessed pain relief, weight gain, and exocrine/endocrine insufficiency during follow-up. The study population comprised 11 men and 1 woman (91.7% vs. 8.3%; mean age, 50.3±6.8years; range 39-61years). Pancreatitis was caused by alcohol in 9 (75%) patients and was idiopathic in 3 (25%) patients. The mean follow-up period was 82.5±46.5months (range 16.9-152.1months). There was no operative mortality, but three patients (25%) suffered postoperative morbidity. All patients were pain-free at the time of discharge. There was no case of new-onset diabetes mellitus after surgery, although one patient (8.3%) suffered exocrine insufficiency. The body weight and body mass index of all patients improved during follow-up. Only one patient continued to suffer pain in the long term. The findings of this long-term follow-up of patients who underwent the Frey procedure suggest that it offers effective pain relief and is a safe technique for the management of CP.

What can be done when the cored specimen in a Frey procedure for chronic pancreatitis is reported as adenocarcinoma?

The aim of this study is to analyze the outcomes of patients with chronic pancreatitis who underwent the Frey procedure and who had a histologic evidence of adenocarcinoma in the cored out specimen.The type of analysis is retrospective. Out of 523 patients who underwent Frey procedure for chronic pancreatitis, seven (five males and two females; age range 42 to 54years) had histologically proven adenocarcinoma. In the first four cases, intraoperative frozen section was not done. The diagnosis was made on routine histopathology and only one out of four could undergo attempted curative therapy. In the remaining three cases, intraoperative frozen section confirmation was available, and curative resection performed. Only four out of seven had a clear-cut mass lesion: (a) cancer can occur in chronic pancreatitis in the absence of a mass lesion and (b) intraoperative frozen section of the cored specimen is crucial to exercising curative therapeutic options and must be performed routinely. If frozen section is reported as adenocarcinoma, a head resection with repeat frozen of the margins of resection is appropriate. If the adenocarcinoma is reported on regular histopathology after several days, then a total pancreatectomy may be more appropriate.

Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis

Surgical outcomes and long-term pain relief after Frey procedure for chronic pancreatitis

Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis

To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis (CP) and patient selection. All consecutive patients undergoing duodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index (BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index (white blood cells, interleukin (IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data (postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients. Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male (85%) and seven were female (16%). The etiology of CP was alcohol in 32 patients (70%) and idiopathic in 14 patients (30%). Stones were found in 38 patients (83%). An inflammatory mass was found in five patients (11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19 (9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7 (17.8-22.4) kg/m(2) and was 20.6 ± 2.9 (15.4-27.7) kg/m(2) in the open group. All patients required analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients (43%). Pre-operative complications due to pancreatitis were observed in 18 patients (39%). Pancreatic functional insufficiency was observed in 14 patients (30%). Two laparoscopic patients (2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29 (290-370) min. Estimated intra-operative blood loss was 57 ± 14 (40-80) mL. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2 (5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass (P < 0.001) and acute exacerbation (P < 0.001) were risk factors for intra-operative blood loss. The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

Short- and long-term results of the Frey procedure for chronic pancreatitis.

The aim of this study was to determine the short- and long-term results of the Frey procedure for chronic pancreatitis. From November 1998 to December 2013, 41 patients underwent the Frey procedure for painful chronic pancreatitis at Kyushu University Hospital. The short- and long-term results of the Frey procedure including mortality, morbidity, pain relief, weight gain and pancreatic endocrine function were analyzed. The long-term results were analyzed in 29 patients who had been followed-up for more than 12 months. The long-term follow-up rate was 85%. There was no mortality. Early postoperative complications occurred in seven patients (17%), including pancreatic fistula in four (10%, International Study Group of Pancreatic Fistula ISGPF grade B) and hemorrhage in three (7%). Long-term relief of abdominal pain was achieved in 90% (26/29) of cases. One patient developed relapse of inflammation of the head of pancreas during the follow-up period, necessitating pylorus-resecting pancreatoduodenectomy. Only two patients (7%) developed new-onset diabetes mellitus after the Frey procedure during the follow-up period. The Frey procedure for painful chronic pancreatitis may be safe and pancreatic endocrine function is preserved. Complete decompression of the pancreatic ducts in the head of pancreas and full length drainage of the main pancreatic duct from the head of pancreas to the tail may be important in the Frey procedure to prevent recurrence of acute inflammation.

511 Re-Interventions After Frey Procedure for Chronic Pancreatitis: Does Radicality of Head Coring Influence Outcomes?

Introduction: Symptomatic gallstone disease during pregnancy is a leading cause of nonobstetric hospitalizations and operations. Although laparoscopic cholecystectomy (LC) is safe and efficacious in pregnancy (SAGES Guidelines, 2011), practice patterns are variable with nonoperative management favored by some providers. The aim of this study was to evaluate practice patterns and outcomes of pregnant patients undergoing nonoperative management for symptomatic cholelithiasis (SC). Methods: We performed a retrospective analysis of all patients who presented to a tertiary care academic center over a 42-month period (Jan 2009-July 2012). Women (age 18 or older) with uncomplicated SC during pregnancy (without cholecystitis, pancreatitis, choledocholithiasis, or cholangitis) were included. Patients were identified by querying an electronic data repository for relevant diagnoses, imaging, and procedure codes. Patients were also contacted via a standardized telephone survey to supplement the chart review and account for outside hospitalizations and treatments. Results: A total of 53 women (mean age 32.4y, SD 6.7) with SC were identified during the study period (Table 1). Mean gestational age at initial presentation was 23 weeks (9 patients in first, 22 in second, and 22 in third trimester). Four women (7.5%) underwent LC in the antepartum period, all in the second trimester (Figure 1). There were no maternal or fetal complications associated with LC. Forty-nine women (92.5%) had initial non-operative management. Of these women, 18 (36.7%) were hospitalized more than once in the antepartum period (range 0-5 hospitalizations). Postpartum LC was performed in 28 women (57.1%), the majority (n=21) within 3 months postpartum. Of women who underwent postpartum LC, 22 (78.6%) had recurrent symptoms postpartum prior to LC, and 14 (50.0%) were readmitted at least once (median 1, range 1-4) postpartum for SC prior to undergoing LC. In the remaining 21 women who never underwent LC (42.9%), long-term follow-up information was available in 15 (six could not be reached for telephone survey). Seven elected to not undergo LC due to absence of postpartum symptoms. Four patients had ongoing symptoms but had not undergone LC (one due to recurrent pregnancy). A single patient died from postpartum bleeding complications. Three women had other comorbid medical conditions, and a decision to defer surgery was made in the postpartum period in conjunction with their providers. Conclusions: A minority of pregnant patients with SC undergo antepartum LC. In the remaining patients, many have multiple antepartum admissions for SC. Furthermore, in those who undergo LC, half do so only after postpartum admission for SC. Given the safety of antepartum LC, early surgical intervention during pregnancy may be the optimal strategy to reduce antepartum and early postpartum admissions. Table 1. Overall Patient Demographics (n=53)

Frey procedure for the treatment of chronic pancreatitis associated with common bile duct stricture

The Frey procedure (FP) is the treatment of choice for symptomatic chronic pancreatitis (CP). In cases of biliary stricture, biliary derivation can be performed by choledochoduodenostomy, Roux-en-Y choledochojejunostomy or, more recently, reinsertion of the common bile duct (CBD) into the resection cavity. The objective of the present study was to evaluate the outcomes associated with each of these three types of biliary derivation. We retrospectively analyzed demographic, CP-related, surgical and follow-up data for patients having undergone FP for CP with biliary derivation between 2004 and 2012 in our university medical center. The primary efficacy endpoint was the rate of CBD stricture recurrence. The secondary endpoints were surgical parameters, postoperative complications, postoperative follow-up and the presence of risk factors for secondary CBD stricture. Eighty patients underwent surgery for CP during the study period. Of these, 15 patients received biliary derivation with the FP. Eight of the FPs (53.3%) were combined with choledochoduodenostomy, 4 (26.7%) with choledochojejunostomy and 3 (20.0%) with reinsertion of the CBD into the resection cavity. The mean operating time was 390 minutes. Eleven complications (73.3%) were recorded, including one major complication (6.7%) that necessitated radiologically-guided drainage of an abdominal collection. The mean (range) length of stay was 17 days (8-28) and the median (range) follow-up time was 35.2 months (7.2-95.4). Two patients presented stricture after CBD reinsertion into the resection cavity; one was treated with radiologically-guided dilatation and the other underwent revisional Roux-en-Y choledochojejunostomy. Three patients presented alkaline reflux gastritis (37.5%), one (12.5%) cholangitis and one CBD stricture after FP with choledochoduodenostomy. No risk factors for secondary CBD stricture were identified. As part of a biliary derivation, the FP gave good results. We did not observe any complications specifically related to surgical treatment of the biliary tract. However, CBD reinsertion into the resection cavity appeared to be associated with a higher stricture recurrence rate. In our experience, choledochojejunostomy remains the "gold standard" for the surgical treatment for CBD strictures.

The Frey Procedure for Chronic Pancreatitis Secondary to Pancreas Divisum

Pancreas divisum is an uncommon congenital anomaly that may result in chronic pancreatitis (chronic pancreatitis secondary to pancreas divisum [CPPD]) and intractable pain. We evaluated the role of the Frey procedure in the management of patients with pain related to CPPD as compared with patients with chronic pancreatitis secondary to alcohol (CPA) or idiopathic causes (ICP). To review our experience with the Frey procedure for the management of chronic pancreatitis related to pancreas divisum. This was a 2-year institutional retrospective of patients undergoing the Frey procedure for chronic pancreatitis related-pain from April 2008 to June 2010. Academic tertiary care referral center. A consecutive sample of 14 patients undergoing the Frey procedure for chronic pancreatitis and disease-related intractable pain. We sought to examine the utility of the Frey procedure in patients with CPPD as compared with CPA and ICP. The Frey procedure. Perioperative outcomes and postoperative narcotic requirement were compared among patient groups. Fourteen patients underwent the Frey procedure. The etiology of the disease was pancreas divisum in 6 patients, alcohol in 5, and idiopathic in 3. The most common indication for surgery was intractable pain, and all patients had undergone endoscopic retrograde cholangiopancreatography for attempted relief in the past. There were no statistically significant differences in median operative time (263 minutes), intraoperative blood loss (425 mL), median length of stay (9.5 days), or rate of morbidity (21%) between the 3 etiologies. Two-thirds of patients required less or no opioid at follow-up, although follow-up was significantly longer for CPPD and ICP than CPA (median, 249, 259, and 42 days, respectively; P < .02). 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.

Extent of Pancreatic Fibrosis as a Determinant of Symptom Resolution After the Frey Procedure: A Clinico-pathologic Analysis

ObjectiveThe aim of this study was to evaluate the association of histopathologic features of chronic pancreatitis and pain relief after the Frey procedure. DesignWe retrospectively analyzed 35 patients who underwent the Frey procedure for chronic pancreatitis over a 5-year period (November 2005 to February 2011). SettingThirty-five patients with varied etiologies of chronic pancreatitis and persistent symptoms were referred to a multi-disciplinary pancreatitis clinic where a consensus decision to recommend surgery was established. The Frey procedure was then performed. Main outcome measuresWe compared symptomatic outcomes with the degree of pancreatic fibrosis, duct dilatation, and presence of pancreatic duct stones based on a blinded evaluation of resected pancreatic tissue. ResultsSymptom resolution was associated with severe or extensive (>75 %) fibrosis and absence of symptom resolution was associated with mild or minimal (<25 %) fibrosis (chi-squared, p value < 0.05). Symptom resolution was associated with pancreatic duct >4 mm and absence of symptom resolution was associated with pancreatic duct ≤4 mm (chi-squared, p value < 0.05). There was no difference in outcomes for patients with and without pancreatic duct stones. ConclusionSymptom resolution after the Frey procedure is more likely in the setting of severe or extensive fibrosis due to chronic pancreatitis.

Frey Procedure for Chronic Pancreatitis in a Child with Duodenal Atresia and Complex Pancreaticobiliary Disorders

A boy aged 2 years and 7 months who had undergone duodeno-duodenostomy for duodenal atresia and annular pancreas in the neonatal period presented with recurrent pancreatitis. ERCP showed an incomplete pancreas divisum associated with pancreaticobiliary maljunction. At 3 years and 8 months of age, we performed a Frey procedure in combination with total excision of the extrahepatic bile duct. The main pancreatic duct was opened in the body and the head was cored out anteriorly. The pancreaticobiliary system was reconstructed with a Roux-en-Y anastomosis. The patient has been free from symptoms with excellent weight gain in the follow-up period of 20 months. The Frey procedure can be a safe and effective operation in children with chronic pancreatitis caused by complex pancreatobiliary disorders associated with duodenal atresia.

Factors affecting outcome after Frey procedure for chronic pancreatitis

Background. Debilitating abdominal pain remains the most common presentation of chronic pancreatitis and the treatment remains challenging. Objective. This prospective study analyzed the outcome of Frey's procedure in patients with inflammatory head mass. Methods. For the period between 2002 and 2007, 77 patients with chronic pancreatitis underwent Frey procedure for intractable abdominal pain. The mean follow-up was 14 months. For the purpose of analysis of the outcome, patients were grouped as poor pain control (19%) and good pain control groups (81%) based on the pain scores during follow-up. Results. There was no 30-day mortality. The logistic regression analysis showed that decreased volume percentage (48%) of head mass resected (p=0.003) and small diameter of the pancreatic duct (p=0.05) were associated with poor pain outcome. Subgroup analysis revealed that patients with small duct disease were associated with increased operative time (p=0.001), poor pain scores (p=0.001), and increased weight loss (p=0.003) during follow-up. Conclusions. Frey procedure can be performed with zero mortality and low morbidity in a high-volume center. It provides good pain relief in majority of the patients. Volume of the head mass cored affects pain outcome. Correlation between poor results in terms of pain relief and weight loss following Frey's procedure, and small duct disease supports the view that duct diameter is an important predictor of pain relief.