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World Journal of Surgery

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01-07-2020 | Chronic Pancreatitis | Original Scientific Report

Frey Procedure Combined with Biliary Diversion for the Treatment of Chronic Pancreatitis-Related Biliary Obstruction: Impact of the Types of Diversion

Authors: Sukanta Ray, Kshaunish Das, Koustav Jana, Roby Das, Dilip Kumar, Sujan Khamrui

Published in: World Journal of Surgery | Issue 7/2020

Abstract

Background

Frey procedure (FP) has become the standard of treatment for patients with painful chronic pancreatitis and inflammatory head mass. Biliary diversion (BD) is necessary when there is persistent biliary obstruction after adequate head coring. The aim of the present study was to assess the impact of types of biliary diversion on short-term outcome and rates of stricture recurrence.

Methods

All the patients, who underwent FP combined with BD between August 2007 and July 2017 in the Department of Surgical gastroenterology, Institute of Postgraduate Medical Education and Research, Kolkata, India, were retrospectively reviewed. The types of BD performed were choledochojejunostomy (Group A) or opening of the CBD in the resection cavity (Group B).

Results

During the study period, 36 patients underwent FP with BD. Choledochojejunostomy was performed in 21 patients and opening of the CBD in the resection cavity in 15 patients. Preoperative characteristics and early surgical outcomes were comparable except the postoperative stay which was longer in those who underwent choledochojejunostomy (p = 0.044). Pain control was similar. Over a median follow-up of 72 months, five patients in the Group B developed stricture recurrence which was significantly higher than those of Group A (p = 0.008).

Conclusion

Choledochojejunostomy combined with FP achieves efficient BD with a lower rate of restricture compared with opening of the CBD in the resection cavity.

Agarwal AK, Raj Kumar K, Agarwal S et al (2008) Significance of splenic vein thrombosis in chronic pancreatitis. Am J Surg 196(2):149–154. https://doi.org/10.1016/j.amjsurg.2007.07.039 CrossRefPubMed

Butler JR, Eckert GJ, Zyromski NJ et al (2011) Natural history of pancreatitis-induced splenic vein thrombosis: a systematic review and meta-analysis of its incidence and rate of gastrointestinal bleeding. HPB (Oxford) 13(12):839–845. https://doi.org/10.1111/j.1477-2574.2011.00375.x CrossRef

Vijungco JD, Prinz RA (2003) Management of biliary and duodenal complications of chronic pancreatitis. World J Surg 27(11):1258–1270. https://doi.org/10.1007/s00268-003-7246-7 CrossRefPubMed

Abdallah AA, Krige JE, Bornman PC (2007) Biliary tract obstruction in chronic pancreatitis. HPB (Oxford) 9:421–428. https://doi.org/10.1080/13651820701774883 CrossRef

Yadegar J, Williams RA, Passaro E Jr et al (1980) Common duct stricture from chronic pancreatitis. Arch Surg 115(5):582–586CrossRef

Stabile BE, Calabria R, Wilson SE et al (1987) Stricture of the common bile duct from chronic pancreatitis. Surg Gynecol Obstet 165(2):121–126PubMed

Huizinga WK, Thomson SR, Spitaels JM et al (1992) Chronic pancreatitis with biliary obstruction. Ann R Coll Surg Engl. 74(2):119–123 Discussion 123-5 PubMedPubMedCentral

Sand JA, Nordback IH (1995) Management of cholestasis in patients with chronic pancreatitis: evaluation of a treatment protocol. Eur J Surg 161(8):587–592PubMed

Eisen GM, Chutkan R, Goldstein JL et al (2000) Endoscopic therapy of chronic pancreatitis. Gastrointest Endosc 52(6 Pt1):843–848CrossRef

10.

Ray S, Ghatak S, Das K et al (2015) Surgical management of benign biliary stricture in chronic pancreatitis: a single-center experience. Indian J Surg 77(Suppl 2):608–613. https://doi.org/10.1007/s12262-013-0940-2 CrossRefPubMed

11.

Strate T, Bachmann K, Busch P et al (2008) Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 134(5):1406–1411. https://doi.org/10.1053/j.gastro.2008.02.056 CrossRefPubMed

12.

Bachmann K, Tomkoetter L, Kutup A et al (2013) Is the Whipple procedure harmful for long-term outcome in treatment of chronic pancreatitis? 15-years follow-up comparing the outcome after pylorus-preserving pancreatoduodenectomy and Frey procedure in chronic pancreatitis. Ann Surg. 258(5):815–820. https://doi.org/10.1097/sla.0b013e3182a655a8Discussion 820-1 CrossRefPubMed

13.

Zhou Y, Shi B, Wu L et al (2015) Frey procedure for chronic pancreatitis: evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: a meta-analysis. Pancreatology 15(4):372–379. https://doi.org/10.1016/j.pan.2015.05.466 CrossRefPubMed

14.

Izbicki JR, Bloechle C, Broering DC et al (1997) Reinsertion of the distal common bile duct into the resection cavity during duodenum-preserving resection of the head of the pancreas for chronic pancreatitis. Br J Surg 84(6):791–792CrossRef

15.

Cataldegirmen G, Bogoevski D, Mann O et al (2008) Late morbidity after duodenum-preserving pancreatic head resection with bile duct reinsertion into the resection cavity. Br J Surg 95(4):447–452CrossRef

16.

Rebibo L, Yzet T, Cosse C et al (2013) Frey procedure for the treatment of chronic pancreatitis associated with common bile duct stricture. Hepatobiliary Pancreat Dis Int 12(6):637–644CrossRef

17.

Merdrignac A, Bergeat D, Rayar M et al (2016) Frey procedure combined with biliary diversion in chronic pancreatitis. Surgery 160(5):1264–1270. https://doi.org/10.1016/j.surg.2016.05.006 CrossRefPubMed

18.

Frey CF, Smith GJ (1987) Description and rationale of a new operation for chronic pancreatitis. Pancreas 2(6):701–707CrossRef

19.

Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213CrossRef

20.

Bassi C, Dervenis C, Butturini G et al (2005) International Study Group on pancreatic fistula definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 138(1):8–13CrossRef

21.

Wente MN, Bassi C, Dervenis C et al (2007) Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 142(5):761–768CrossRef

22.

Wente MN, Veit JA, Bassi C et al (2007) Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery 142(1):20–25CrossRef

23.

Koch M, Garden OJ, Padbury R et al (2011) Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery 149(5):680–688. https://doi.org/10.1016/j.surg.2010.12.002 CrossRefPubMed

24.

Bloechle C, Izbicki JR, Knoefel WT et al (1995) Quality of life in chronic pancreatitis-results after duodenum-preserving resection of the head of the pancreas. Pancreas 11(1):77–85CrossRef

25.

Frey CF, Suzuki M, Isaji S (1990) Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 14(1):59–69. https://doi.org/10.1007/bf01670547 CrossRefPubMed

Title: Frey Procedure Combined with Biliary Diversion for the Treatment of Chronic Pancreatitis-Related Biliary Obstruction: Impact of the Types of Diversion
Authors: Sukanta Ray
Kshaunish Das
Koustav Jana
Roby Das
Dilip Kumar
Sujan Khamrui
Publication date: 01-07-2020
Publisher: Springer International Publishing
Keyword: Chronic Pancreatitis
Published in: World Journal of Surgery / Issue 7/2020
Print ISSN: 0364-2313
Electronic ISSN: 1432-2323
DOI: https://doi.org/10.1007/s00268-020-05465-7

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Frey Procedure Combined with Biliary Diversion for the Treatment of Chronic Pancreatitis-Related Biliary Obstruction: Impact of the Types of Diversion

Abstract

Background

Methods

Results

Conclusion

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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