Frey Procedure 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.

Experience in treating patients with autoimmune pancreatitis

Objective — to establish the main diagnostic signs of autoimmune pancreatitis and aspects of patient treatment. Materials and methods. The study analyzed the results of examination and treatment of 17 patients with autoimmune pancreatitis (AIP) from 2010 to 2022. Among the total number of patients with AIP, there were 11 men (65%) and 6 women (35%). The average age of the patients was 52.4 years. Among all patients with AIP, focal involvement of the pancreas was found in 3 (18%) patients, with a predominant involvement of the head of the pancreas. Segmental form of AIP was diagnosed in 6 (35%) patients, while diffuse form was found in 8 (47%) patients. Type 1 AIP was identified in 13 (76%) patients, and type 2 AIP in 4 (24%) patients. For all patients suspected of AIP, the HISORt criteria were assessed: instrumental visualization, serological and histological verification, determination of the volume of pancreatic involvement, and response to steroid therapy. Results. Recurrence of AIP was observed in 8 (47.0%) patients with type 1 AIP and 1 (5.8%) patient with type 2 AIP. AIP recurred in patients with proximal bile duct involvement, diffuse pancreatic involvement, persistently elevated IgG4 levels after steroid induction, delayed radiological remission, and damage to more than two organs. Increased serum levels of IgG, IgG4, apnd eosinophilia indicated a recurrence of IgG4‑RD. A repeat induction of steroids was performed in patients with recurrent AIP, which proved to be very effective, resulting in high remission rates, specifically in 7 (70%) patients with type 1 AIP and in 1 (100%) patient with type 2 AIP. Among all AIP patients that were operated on, 3 (40%) underwent Roux‑en‑Y hepaticojejunostomies, 1 (20%) pancreaticoduodenectomy, and 1 (20%) a Frey procedure. Conclusions. The low incidence of AIP necessitates the use of a clear diagnostic algorithm, and the peculiarities of the disease’s course require compliance with all the principles of conservative treatment and surgical interventions in case of surgical complications.

Long-term symptom resolution following the surgical management of chronic pancreatitis

BackgroundPervasive symptoms from chronic pancreatitis despite noninvasive management is an indication for surgical intervention. Frey and Whipple procedures are appropriate options for proximal pancreas disease; however, data are limited on symptomatic outcomes. MethodsWe conducted a retrospective analysis of patients who underwent surgical intervention for chronic pancreatitis of the proximal pancreas from 2005 to 2019. Preoperative patient characteristics and postoperative outcomes were evaluated. ResultsOne hundred forty patients underwent surgical intervention for chronic pancreatitis, 91 Whipple and 49 Frey procedures. Mean age was 53 years (SD 12), and mean BMI 24 (SD 5.6). At post-operative follow-up, 74 ​% were asymptomatic, and 84 ​% at average follow-up of 2 years. Groove pancreatitis, lack of post-operative delayed gastric emptying, and decreased length of stay were predictive of symptom resolution. ConclusionsWhipple and Frey procedures are appropriate surgical options for chronic pancreatitis affecting the proximal pancreas. Both lead to sustained symptom resolution for most patients.

Genetic background and sex influence somatosensory sensitivity and oxycodone analgesia in the Hybrid Rat Diversity Panel.

Opioid use disorder (OUD) is an ongoing public health concern in the United States, and relatively little work has addressed how genetic background contributes to OUD. Understanding the genetic contributions to oxycodone-induced analgesia could provide insight into the early stages of OUD development. Here, we present findings from a behavioral phenotyping protocol using several inbred strains from the Hybrid Rat Diversity Panel. Our behavioral protocol included a modified "up-down" von Frey procedure to measure inherent strain differences in the sensitivity to a mechanical stimulus on the hindpaw. We also performed the tail immersion assay, which measures the latency to display tail withdrawal in response to a hot water bath. Initial withdrawal thresholds were taken in drug-naïve animals to record baseline thermal sensitivity across the strains. Oxycodone-induced analgesia was measured after administration of oxycodone over the course of 2 h. Both mechanical and thermal sensitivity are shaped by genetic factors and display moderate heritability (h2 = 0.23-0.40). All strains displayed oxycodone-induced analgesia that peaked at 15-30 min and returned to baseline by 2 h. There were significant differences between the strains in the magnitude and duration of their analgesic response to oxycodone, although the heritability estimates were quite modest (h2 = 0.10-0.15). These data demonstrate that genetic background confers differences in mechanical sensitivity, thermal sensitivity, and oxycodone-induced analgesia.

Considering Frey’s procedure as primary surgical management in chronic pancreatitis and pancreatic stone: A case report

Chronic pancreatitis (CP) is characterized by abdominal pain, recurrent acute pancreatitis episodes, and pancreatic fibrosis, which leads to endocrine and exocrine insufficiency. Back in 1987, Frey and Smith demonstrated pancreatic head anterior resection combined with drainage of the main pancreatic duct using pancreaticojejunostomy. A 52-year-old man complained of right upper abdominal pain for 2 weeks. MRI examination presented prominent dilatation of the left and right intrahepatic ducts, and common bile duct due to the main pancreatic duct massive dilatation, accompanied by an irregular filling defect that adhesions to the wall, suggesting pancreatic stones. The patient was diagnosed with chronic calcifying pancreatitis with pancreatic stones. Frey’s procedure was chosen as primary surgical management. When conservative therapy fails to relieve the pain from chronic pancreatitis, physicians should consider surgery as a primary intervention. We recommend Frey's procedure for chronic pancreatitis treatment because of its safety and effectiveness.

Long term results of Frey Procedure in chronic pancreatitis with small duct disease

Long term results of Frey Procedure in chronic pancreatitis with small duct disease

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

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

Post-surgical exocrine pancreatic insufficiency.

Being an underdiagnosed and under or insufficiently treated condition, surgical pancreatic exocrine insufficiency (PSP) is the condition in which pancreatic enzymes are insufficient for digestion because of gastrointestinal (GI) surgery involving the upper GI tract, biliary ducts, or the pancreas, and and leading to potential malnutrition and deterioration in quality of life. Age, obesity, history of tobacco use, family history of diabetes, surgery due to a malignant tumor, presence of steatorrhea, jaundice, weight loss, and intraoperative findings of hard pancreatic texture have been associated with a higher risk of PSP. Pancreatoduodectomy (PD) has demonstrated an increased risk of developing PSP, with a prevalence between 19-100%. Distal pancreatectomy (DP) and central pancreatectomy (CenP) are associated with less risk of PSP, with a prevalence of 0-82% and 3.66-8.7%, respectively. In patients with chronic pancreatitis (CP), PSP was associated with 80% in Partington-Rochelle procedure, 86% in Frey procedure, 80% in duodenum preserving pancreatic head procedure, >60% in PD and 27.5-63% in DP. Fecal elastase-1 (FE-1) is a generally accepted tool for diagnosis. Treatment is recommended to start as soon as a diagnosis is achieved, or clinical suspicion is high. Pancreatic enzyme replacement therapy improves symptoms of malabsorption, facilitates weight gain, and ultimately improves patients' quality of life. Starting dosage is between 10,000-50,000 units in snacks and 50,000-75,000 units in main meals, administered throughout food intake, though further data specifically on PSP are needed. Follow-up in PSP is recommended on an on-demand basis, where malnutrition should be assessed.

Long-term outcomes of laparoscopic longitudinal pancreatojejunostomy and modified Frey's procedure for patients of chronic pancreatitis: A 10-year experience.

To mitigate the morbidity associated with open procedures for chronic pancreatitis (CP), there is a paradigm shift towards the laparoscopic approach. However, since these procedures are technically demanding, literature is still limited. We present our experience and long-term outcomes in the management of CP with laparoscopic surgical procedures. This is a retrospective observational study of patients who underwent a laparoscopic surgery for CP between 2009 and 2019. Pain scores using the Visual Analogue Scale (VAS) were compared pre- and postoperatively. In patients with diabetes, the pre- and post-operative insulin requirement was compared. Data of 62 patients were analysed. The mean duration of follow-up was 69 (±22) months. All patients had pain relief post-surgery. The relief of pain was sustained, with the median VAS scores being 1 at 3- and 5-year follow-up. There was a decrease in the median insulin requirement of diabetic patients, which was significant at 3-month and 1-year follow-up ( P < 0.05). Our study demonstrates that laparoscopic surgical procedures offer long-term pain control with low morbidity. Effective ductal decompression may result in a short-term improvement of the endocrine function of the gland.

Comparative Study of Different Types of Pancreatic Head Resection for Chronic Pancreatitis

For the surgical treatment of chronic pancreatitis with inflammatory head enlargement, several types of resections are available, like the Beger, Frey, Berne, and Whipple procedures. The present work gives a comparison of these techniques and new recommendations about the pancreatojejunal and the biliary anastomosis. Two hundred thirty pancreatic head resections were performed during the last 30 years. Pre-, intra-, and postoperative data were analyzed, respectively. A questionnaire was used to investigate the late results. The statistical analysis proved that the Berne and the Frey procedure were the most advantageous regarding the length of the operation, the need for transfusion, the postoperative intensive care unit, and total hospital stay. The early morbidity rate was significantly better after the Frey, than after the Whipple procedure. There were no differences between the operations, concerning the reoperation and mortality rates. Patients’ quality of life was acceptable, despite the continuous alcohol and nicotine abuse in most of them. Due to the better early outcomes, both the Frey and the Berne operations are preferable; however, the latter one is technically the simplest and the shortest intervention. During both procedures, a modification of the pancreatojejunal anastomosis and, in case of a cholestasis, an extrapancreatic biliodigestive anastomosis are recommended, due to the advantageous experiences.

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.

Total robotic lateral pancreaticojejunostomy and modified Frey's procedure for chronic calcific pancreatitis.

Surgical intervention has been shown to have good post-operative outcomes in patients with chronic pancreatitis with pain refractory to oral analgesics. We present our initial experience with robotic lateral pancreaticojejunostomy (LPJ) and modified Frey's procedure (MFP). Patients with chronic calcific pancreatitis were evaluated with routine biochemical and radiological investigations. The indication of surgery was intractable pain which was recorded by an Intensity Frequency, Consequence (IFC) pain score. The patient was placed in a reverse Trendelenburg position with four 8-mm robotic ports and one 12-mm assistant port. Robotic ultrasound was utilized to identify the pancreatic duct. After retrieving all the calculi, which was confirmed by pancreatoscopy with the help of a video choledochoscope and performing the head coring in particular cases, the Roux-en-Y LPJ was performed. Among five patients (4 males, one female), robotic LPJ was performed in 2 and MFP in 3 patients. The cohort's median age was 32 (interquartile range (IQR), 28, 40) years, and the median (IQR) pancreatic duct size was 9 (9, 13) mm. The median (IQR) duration of the procedure was 385 (380, 405) minutes, with a median (IQR) blood loss of 100 (50-100) ml, and the patients were discharged on median post-operative day 5. The patients continue to do well at a median follow-up of 3-30months without the requirement of oral analgesics. Robotic LPJ and MFP are feasible in experienced hands with good post-operative outcomes and enhanced quality of life. Intra-operative pancreatoscopy with the help of a choledochoscope can be utilized to ascertain the complete clearance of pancreatic duct stones and the consequent pain relief.

LONG-TERM OUTCOMES FOLLOWING FREY'S PROCEDURE FOR CHRONIC PANCREATITIS – A TEN-YEARS OF SINGLE-CENTER EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Background/Aim: Chronic pancreatitis (CP) is surgically treated in selected patient populations. Frey's procedure (FP) is the most commonly described procedure for CP with head mass. This study is being conducted to determine the long-term outcome and efcacy of FP in patients with CP in South India of various etiologies. Methods: This is a retrospective study of patients who underwent FP at our institution. Clinical features, perioperative ndings, and follow-up results were evaluated. A subgroup analysis of pain relief was performed between alcoholics and non-alcoholic groups and between patients receiving FP alone and FP with additional procedures. Results: Of the 181 patients, alcohol was the causative factor in 99 (54.69%), gallstones in 20 (11.04%), and idiopathic in 62 (34.25%). With a median follow-up of 43.49 months (range 12-72 months), 78 (43.09%) patients experienced complete pain relief. Due to persistent pain and the presence of preoperative diabetes mellitus (DM), pain relief in patients with postoperative complications was incomplete. New DM and exocrine dysfunction were reported in 25 years (13.81%) and 15 (8.28%) patients. Patients with a history of alcohol abuse, smoking, weight loss, and postoperative complications are associated with newly developed diabetes. Conclusion: FP is a safe surgical option for CP with acceptable perioperative complications and appropriate short-term and long-term pain management in properly selected patients. Continuous pain and preoperative DM were independent predictors of incomplete pain relief after FP. Symptoms associated with alcohol abuse, smoking, and weight loss were associated with the development of post-FP DM in the study population.

Early experience with robot-assisted Frey's procedure surgical outcome and technique: Indian perspective.

Robotic surgery for pancreatic diseases is currently on the rise, feasible, well-accepted, and safe. Frequently performed procedures in relation to pancreatic diseases include distal pancreatectomy and pancreatoduodenectomy. The literature commonly describes robotic lateral pancreaticojejunostomy; however, data on robot-assisted Frey's is scarce. We herein, describe our series and technique of robot-assisted Frey's procedure at our tertiary care center between November 2019 and March 2022, and its short-term outcomes in comparison to the open Frey's. Patients with chronic pancreatitis having intractable pain, dilated duct, and no evidence of inflammatory head mass or malignancy were included in the study for robot-assisted Frey's. In our study, out of 32 patients, nine patients underwent robot assisted Frey's procedure. The duration of surgery was significantly longer in robotic group (570 minutes vs. 360 minutes, p = 0.003). The medians of intraoperative blood loss and postoperative analgesic requirement were lower in robotic group, but the difference was not statistically significant (250 mL vs. 350 mL, p = 0.400 and 3 days vs. 4 days, p = 0.200, respectively). The median length of hospital stay was shorter in the robotic group, though not significant (6 days vs. 7 days, p = 0.540). At a median follow-up of 28 months, there was no significant difference in the postoperative complications and short-term outcomes between the two groups. Robotic surgery offers benefits of laparoscopic surgery in addition it has better visualization, magnification, dexterity, and ergonomics. Frey's procedure is possible robotically with acceptable outcomes in selected patients.

Outcomes after Frey’s procedure for chronic pancreatitis: a 8-year single-center experience in Colombia

BackgroundChronic pancreatitis is an inflammatory disease characterized by irreversible morphological changes due to chronic pancreatic fibrosis. The treatment goals are to relieve pain, preserve function, and prevent further pathological consequences. Endoscopic treatment, surgery, or both are options for untreatable pain or suspected malignancy. Frey procedure is a reasonable surgical intervention because of its hybrid character, combining resection and drainage. Unfortunately, there is limited information about the outcomes of this procedure in Latin America, and few cases described in Colombia. This study aims to describe the experience of a pancreatic surgery reference center in the management of patients undergoing Frey’s surgery for chronic pancreatitis.MethodsA retrospective review of a prospectively collected database of patients who underwent a Frey procedure due to chronic pancreatitis between January 2014 to February 2022 in a hospital in Bogotá, Colombia, was made. A demographic, clinical, and postoperative outcome description was performed. Mann–Whitney Willcoxon test was performed between operative variables and long-term outcomes.ResultsEighteen patients met the inclusion criteria. 55.5% of patients were male. Chronic pancreatitis etiology in most cases (83.3% n = 15) was idiopathic. The median duration of symptoms and chronic pancreatitis diagnosis before surgery was 6.15 months (IQR 5;97). Overall morbidity was 38.88%. One patient died at 30 days of follow-up. The median follow-up time was 42.5 (IQR 19;65 months). The median pain reduction was 3 points according to the visual analog score. Six patients were diagnosed with malignant conditions after surgery (mean 27.8 ± 7.5 months). Wirsung’s duct size was statistically related with malignancy presentation after Frey’s procedure (Z = 2.54; P = 0.01).ConclusionAccording to our data, Frey’s procedure remains safe and feasible, with acceptable outcomes in terms of pain relief and pancreatic function. The study confirms the importance of a longstanding follow-up due to an inherent risk of pancreatic malignancy. Our data suggest that pancreatic duct size could be related with the malignancy diagnosis after Frey’s procedure; however, further prospective studies with a larger sample size would be helpful to confirm these results.

HPB P69 Minimally invasive versus open management of chronic pancreatitis - A systematic review

Abstract Background Surgical treatment for chronic pancreatitis (CP) is usually performed via an open approach through drainage (pancreaticojejunostomy) or resection (pancreaticoduodenectomy, Beger) procedures or a combination of both (Frey's procedure). Minimally invasive (laparoscopic, robotic) management for patients with CP represents a technical challenge. The aim of this systematic review is to report the outcomes of these minimally invasive procedures among themselves and compare them with reported data from the literature for open procedures. Methods A systematic literature search using Embase and Medline was performed to identify articles reporting CP. Results Twelve studies with 186 patients undergoing a laparoscopic procedure for their intractable abdominal pain caused by their CP. Sixty-six-point six percent of patients (n=124) underwent a laparoscopic drainage procedure while 33.3% (n=62) had a partial or total resection of their pancreas. Total pain relief was achieved in 66.7–100% following laparoscopic pancreatojejunostomy, 93% following laparoscopic Frey's procedure, 90% following laparoscopic total pancreatectomy and islet transplantation and 70% following laparoscopic distal pancreatectomy. Conclusions Laparoscopic procedures for CP are safe and feasible for a carefully selected group of patients. However, more robust comparisons are required between laparoscopic and open approaches in the form of multi-centre randomised controlled trials.

Pancreatic cancer in chronic pancreatitis – the diagnostic and therapeutic dilemma; an overview of cases

Introduction: Any mass in chronic pancreatitis (CP) is a difficult diagnostic and therapeutic problem. The aim of the study is a) to use our own group to determine the actual incidence of non-malignant masses in CP where any mass is highly suspected of being malignant; and b) to determine the actual incidence of malignant tumors in CP. Methods: We present a retrospective analysis of our group of patients operated in 2015–2019 for CP, a mass in CP and suspected malignancy in the mass in CP. Additionally, we present difficult cases in terms of preoperative diagnosis. Results: Thirty-three of 340 (9.7%) pancreatic resection were done due to any form of chronic pancreatitis in 2015–2019. A mass in the pancreatic head was present in 16 (48%) patients; of these, pancreatic ductal adenocarcinoma (PDAC) was suspected in 10 (62%) patients based on EUS, CT or PETCT, and also based on positive tissue diagnosis using EUS-FNA in 6 cases. Bypass or Frey procedure were done in 59 patients (HJA, PJA, Frey). Preoperative tissue sampling was done in 8 (13%) patients and malignancy was suspected in 25%. Intraoperatively, malignancy was confirmed only in one patient assessed as non-malignant in the preoperative period. The clinical course in 3 other patients undergoing HJA, although tumor-free at the time of the surgery, indicated PDAC in CP. Conclusion: The ability to detect malignant cells in a mass in CP remains poor even using all of the available sophisticated methods and the success depends on many variable factors. The rate of “unnecessary” right-sided resections of a mass in CP reached 48% in our patient group, while the rate of resections which should have been performed instead of bypass procedures was 7%. A certain percentage of the so-called excessive pancreatic resections, as well as the failure to perform a resection due to an undetected/unrecognized pancreatic tumor in CP should continue to be expected.

“OUTCOME OF FREY'S PROCEDURE FOR CHRONIC PANCREATITIS”

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.

Laparoscopic versus open Frey procedure: Comparative analysis of short and long-term outcomes

BackgroundFrey procedure is one of the most common surgical treatment options for chronic pancreatitis. The data on safety and effectiveness of laparoscopic approach in Frey procedure are very limited. In the present study a comparative analysis of the short- and long-term outcomes of laparoscopic versus open Frey procedure was demonstrated. MethodsSeventy-nine consecutive patients with chronic pancreatitis submitted to either open (n – 29) (OFP) or laparoscopic (n – 50) (LFP) Frey procedure between September 2012 and January 2020, were evaluated. ResultsThe laparoscopic approach was performed fully on 45 (90%) patients. Conversion was needed in 4 (8%) cases, 1 patient (2%) was converted to laparoscopic Beger procedure. The median operative time was 420 (290–685) min after LFP and 310 (179–515) min after OFP. The blood loss was 100 (30–700) ml and 225 (50–1200) ml, respectively. The pain score on POD 3 was 2 (1–4) in LFP group and 4 (2–8) after OFP. The length of hospital stay was 6 (3–25) days after LFP and 9.5 (5–42) days after OFP. In the LFP and OFP groups the postoperative complications occurred in 11 (24.4%) and 8 (28.5%) patients, respectively. The follow-up period lasted for 36 (6–60) months after LFP and 60 (6–60) months after OFP. Poor pain control with the need for non-opioid analgesics intake was observed in 4 patients in the LFP group and in 3 patients after OFP. ConclusionsLaparoscopic Frey procedure is an efficient and safe intervention, which provides all the advantages of the minimally invasive approach.

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.