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Published in: Journal of Gastrointestinal Surgery 7/2012

01-07-2012 | Original Article

Frey Procedure in Patients with Chronic Pancreatitis: Short and Long-term Outcome from a Prospective Study

Authors: Alexandra M. D. Roch, Dorothée Brachet, Emilie Lermite, Patrick Pessaux, Jean-Pierre Arnaud

Published in: Journal of Gastrointestinal Surgery | Issue 7/2012

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Abstract

Background

The aim of this prospective study was to determine the short- and long-term results of the Frey procedure in the treatment of chronic pancreatitis.

Methods

From September 2000 to November 2009, 44 consecutive patients underwent the Frey procedure. Patients were included in the study before surgery and followed prospectively with assessment of pain relief, weight gain and exocrine/endocrine insufficiency. Twenty-one patients (47.7 %) were followed for more than 5 years.

Results

This study included 40 men (91 %) and four women (9 %) (mean age: 49 years) with a mean follow-up of 51.5 months. The primary etiology of chronic pancreatitis was chronic alcohol abuse in 38 patients (86.4 %). The major indication for surgery was disabling pain (95.5 %). There was no postoperative mortality. Postoperative morbidity occurred in 15 patients (34.1 %), with specific surgical complications in 11 patients (25 %). The percentage of pain-free patients after surgery was 68.3 %. Eight patients (18.1 %) and seven patients (16 %) developed diabetes de novo and exocrine insufficiency, respectively. The Body Mass Index showed statistically significant improvement during follow-up. Similar beneficial results concerning pain relief and weight gain persisted after the initial 5-year follow-up.

Conclusions

The Frey procedure is an appropriate, safe and effective technique for management of patients with chronic pancreatitis in the absence of neoplasia, based on long-term follow-up.
Literature
1.
go back to reference Andren-Sandberg A, Hoem D, Gislason H. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol 2002; 14:957–70.PubMedCrossRef Andren-Sandberg A, Hoem D, Gislason H. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol 2002; 14:957–70.PubMedCrossRef
2.
go back to reference Tsiotou AG, Sakorafas GH. Pathophysiology of pain in chronic pancreatitis. Clinical implications from a surgical perspective. Int Surg 2000; 85:291–6.PubMed Tsiotou AG, Sakorafas GH. Pathophysiology of pain in chronic pancreatitis. Clinical implications from a surgical perspective. Int Surg 2000; 85:291–6.PubMed
4.
go back to reference Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 2010; 251(1): 18–32.PubMedCrossRef Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 2010; 251(1): 18–32.PubMedCrossRef
5.
go back to reference Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958; 76:898–907.PubMedCrossRef Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958; 76:898–907.PubMedCrossRef
6.
go back to reference Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2007; 6:121–33.PubMed Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2007; 6:121–33.PubMed
7.
go back to reference Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987; 2:701–7.PubMedCrossRef Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987; 2:701–7.PubMedCrossRef
8.
go back to reference Ho HS, Frey CF. The Frey procedure. Local resection of pancreatic head combined with lateral pancreaticojejunostomy. Arch Surg 2001; 136:1333–8.CrossRef Ho HS, Frey CF. The Frey procedure. Local resection of pancreatic head combined with lateral pancreaticojejunostomy. Arch Surg 2001; 136:1333–8.CrossRef
9.
go back to reference Pessaux P, Kianmanesh R, Regimbeau JM et al. Frey procedure in the treatment of chronic pancreatitis short-term results. Pancreas 2006; 33:354–8.PubMedCrossRef Pessaux P, Kianmanesh R, Regimbeau JM et al. Frey procedure in the treatment of chronic pancreatitis short-term results. Pancreas 2006; 33:354–8.PubMedCrossRef
10.
go back to reference Frey CF, Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 1994; 220:492–507.PubMedCrossRef Frey CF, Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann Surg 1994; 220:492–507.PubMedCrossRef
11.
go back to reference Falconi M, Bassi C, Casetti L et al. Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006; 10:504–10.PubMedCrossRef Falconi M, Bassi C, Casetti L et al. Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastrointest Surg 2006; 10:504–10.PubMedCrossRef
12.
go back to reference Strate T, Taherpour Z, Bloechle C, et al. Long-term follow-up of a randomized trial comparing the Beger and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005; 241:591–8.PubMedCrossRef Strate T, Taherpour Z, Bloechle C, et al. Long-term follow-up of a randomized trial comparing the Beger and Frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005; 241:591–8.PubMedCrossRef
13.
go back to reference Keck T, Wellner UF. Long-term outcome after 92 duodenum-preserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures. J Gastrointest Surg 2010; 14:549–56.PubMedCrossRef Keck T, Wellner UF. Long-term outcome after 92 duodenum-preserving pancreatic head resections for chronic pancreatitis: comparison of Beger and Frey procedures. J Gastrointest Surg 2010; 14:549–56.PubMedCrossRef
14.
go back to reference Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, Yekebas E, Kuechler T, Bloechle C, Izbicki JR. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 2008; 134(5): 1406–11.PubMedCrossRef Strate T, Bachmann K, Busch P, Mann O, Schneider C, Bruhn JP, Yekebas E, Kuechler T, Bloechle C, Izbicki JR. Resection vs drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 2008; 134(5): 1406–11.PubMedCrossRef
15.
go back to reference Lankisch PG, Andren-Sandberg A. Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment. Int J Pancreatol 1993; 14:205–12.PubMed Lankisch PG, Andren-Sandberg A. Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment. Int J Pancreatol 1993; 14:205–12.PubMed
16.
go back to reference Schnelldorfer T., Adams D.B. Surgical treatment of alcohol-associated chronic pancreatitis: the challenges and pitfalls. Am Surg 2008;74(6):503–7.PubMed Schnelldorfer T., Adams D.B. Surgical treatment of alcohol-associated chronic pancreatitis: the challenges and pitfalls. Am Surg 2008;74(6):503–7.PubMed
17.
go back to reference Frey C, Suzuki M, Isaji S. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 1990; 14:59–69.PubMedCrossRef Frey C, Suzuki M, Isaji S. Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. World J Surg 1990; 14:59–69.PubMedCrossRef
19.
go back to reference WHO/ADA. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20:1183–97. WHO/ADA. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20:1183–97.
20.
go back to reference Cancer pain relief guidelines. 1st edition. World Health Organization, Geneva, Switzerland 1986. The WHO analgesic ladder. Cancer pain relief guidelines. 1st edition. World Health Organization, Geneva, Switzerland 1986. The WHO analgesic ladder.
21.
go back to reference Dindo D., Demartine N., Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–13.PubMedCrossRef Dindo D., Demartine N., Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 2004; 240:205–13.PubMedCrossRef
22.
go back to reference Bassi C, Dervenis C, Butturini G et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138(1): 8–13.PubMedCrossRef Bassi C, Dervenis C, Butturini G et al. International Study Group on Pancreatic Fistula Definition. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005; 138(1): 8–13.PubMedCrossRef
23.
go back to reference Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142(5): 761–8.PubMedCrossRef Wente MN, Bassi C, Dervenis C, Fingerhut A, Gouma DJ, Izbicki JR, Neoptolemos JP, Padbury RT, Sarr MG, Traverso LW, Yeo CJ, Büchler MW. Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 2007; 142(5): 761–8.PubMedCrossRef
24.
go back to reference Epi Info Software Version 3.5.1 (January 2009). Community Health Assessment Tutorial Document version 2.0. Department of Health and Human Services, Centers for Disease Control and Prevention. Epi Info Software Version 3.5.1 (January 2009). Community Health Assessment Tutorial Document version 2.0. Department of Health and Human Services, Centers for Disease Control and Prevention.
25.
go back to reference Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure). World J Surg 2003; 27:1217–30.PubMedCrossRef Frey CF, Mayer KL. Comparison of local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey procedure) and duodenum-preserving resection of the pancreatic head (Beger procedure). World J Surg 2003; 27:1217–30.PubMedCrossRef
26.
go back to reference Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized trial. Ann Surg 1995; 221:350–8.PubMedCrossRef Izbicki JR, Bloechle C, Knoefel WT, et al. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis: a prospective, randomized trial. Ann Surg 1995; 221:350–8.PubMedCrossRef
27.
go back to reference Chaudhary A, Negi SS, Massod S, et al. Complications after Frey’s procedure for chronic pancreatitis. IS J Surg. 2004; 188:277–81. Chaudhary A, Negi SS, Massod S, et al. Complications after Frey’s procedure for chronic pancreatitis. IS J Surg. 2004; 188:277–81.
28.
go back to reference Izbicki JR, Bloechle C, Knoefel WT, et al. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 1999; 79:913–44.PubMedCrossRef Izbicki JR, Bloechle C, Knoefel WT, et al. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 1999; 79:913–44.PubMedCrossRef
29.
go back to reference Schnelldorfer T, Lewin DN, Adams DB. Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis? Hepatogastroenterology 2005; 52:1878–82.PubMed Schnelldorfer T, Lewin DN, Adams DB. Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis? Hepatogastroenterology 2005; 52:1878–82.PubMed
30.
go back to reference Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960; 152:1037–43.PubMedCrossRef Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960; 152:1037–43.PubMedCrossRef
31.
go back to reference Paye F, Nicoluzzi E, Calicis B, Balladur P, Tiret E, Parc R. Influence de l’obstruction canalaire céphalique résiduelle sur les résultats de la dérivation pancréatico-jéjunale dans la pancréatite chronique. Gastroenterol Clin Biol 2001; 25: 755–60.PubMed Paye F, Nicoluzzi E, Calicis B, Balladur P, Tiret E, Parc R. Influence de l’obstruction canalaire céphalique résiduelle sur les résultats de la dérivation pancréatico-jéjunale dans la pancréatite chronique. Gastroenterol Clin Biol 2001; 25: 755–60.PubMed
32.
go back to reference Frey CF. The surgical management of chronic pancreatitis: The Frey procedure. Adv Surg 1999; 32: 41–85.PubMed Frey CF. The surgical management of chronic pancreatitis: The Frey procedure. Adv Surg 1999; 32: 41–85.PubMed
33.
go back to reference Shrikhande SV, Kleeff J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006; 10(2): 227–33.PubMedCrossRef Shrikhande SV, Kleeff J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006; 10(2): 227–33.PubMedCrossRef
34.
go back to reference Beger HG, Buechler M. Duodenum preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. World J Surg 1990; 14:83–7.PubMedCrossRef Beger HG, Buechler M. Duodenum preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. World J Surg 1990; 14:83–7.PubMedCrossRef
35.
go back to reference Izbicki JR, Bloechle C, Broering DC, et al. Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatico-duodenectomy. Ann Surg 1998; 228:771–9.PubMedCrossRef Izbicki JR, Bloechle C, Broering DC, et al. Extended drainage versus resection in surgery for chronic pancreatitis: a prospective randomized trial comparing the longitudinal pancreaticojejunostomy combined with local pancreatic head excision with the pylorus-preserving pancreatico-duodenectomy. Ann Surg 1998; 228:771–9.PubMedCrossRef
36.
go back to reference Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg 2008; 247:950–61.PubMedCrossRef Diener MK, Rahbari NN, Fischer L, et al. Duodenum-preserving pancreatic head resection versus pancreaticoduodenectomy for surgical treatment of chronic pancreatitis: a systematic review and meta-analysis. Ann Surg 2008; 247:950–61.PubMedCrossRef
37.
go back to reference Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman J, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg 2000; 231:890–8.PubMedCrossRef Huang JJ, Yeo CJ, Sohn TA, Lillemoe KD, Sauter PK, Coleman J, et al. Quality of life and outcomes after pancreaticoduodenectomy. Ann Surg 2000; 231:890–8.PubMedCrossRef
38.
go back to reference Strate T, Bachmann K, Busch P, et al. Resection vs. drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 2008; 134:1406–11.PubMedCrossRef Strate T, Bachmann K, Busch P, et al. Resection vs. drainage in treatment of chronic pancreatitis: long-term results of a randomized trial. Gastroenterology 2008; 134:1406–11.PubMedCrossRef
39.
go back to reference Adam U, Makowiec F, Riediger H, et al. Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension. Surgery 2004; 135:411–8.PubMedCrossRef Adam U, Makowiec F, Riediger H, et al. Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension. Surgery 2004; 135:411–8.PubMedCrossRef
40.
41.
go back to reference Desai CS, Stephenson DA, Khan KM, Jie T, Gruessner AC, Rilo HL, Gruessner RW. Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg 2011; 213(6): 29–34.CrossRef Desai CS, Stephenson DA, Khan KM, Jie T, Gruessner AC, Rilo HL, Gruessner RW. Novel technique of total pancreatectomy before autologous islet transplants in chronic pancreatitis patients. J Am Coll Surg 2011; 213(6): 29–34.CrossRef
42.
go back to reference Hartel M, Tempia-Caliera AA, Wente MN, et al. Evidence-based surgery in chronic pancreatitis. Langenbecks Arch Surg. 2003; 388:132–9.PubMed Hartel M, Tempia-Caliera AA, Wente MN, et al. Evidence-based surgery in chronic pancreatitis. Langenbecks Arch Surg. 2003; 388:132–9.PubMed
Metadata
Title
Frey Procedure in Patients with Chronic Pancreatitis: Short and Long-term Outcome from a Prospective Study
Authors
Alexandra M. D. Roch
Dorothée Brachet
Emilie Lermite
Patrick Pessaux
Jean-Pierre Arnaud
Publication date
01-07-2012
Publisher
Springer-Verlag
Published in
Journal of Gastrointestinal Surgery / Issue 7/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-012-1904-8

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