Long-Term Outcome after 92 Duodenum-Preserving Pancreatic Head Resections for Chronic Pancreatitis: Comparison of Beger and Frey Procedures
Purchase on Springer.com
$39.95 / €34.95 / £29.95*
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.
Duodenum-preserving pancreatic head resection may be an alternative to pancreatoduodenectomy or drainage procedures for chronic pancreatitis. There are few studies directly comparing the long-term outcome after the operations described by Beger and Frey.
One hundred thirteen patients underwent duodenum-preserving pancreatic head resection for complications of chronic pancreatitis. Follow-up was obtained in 92 patients (42 Beger, 50 Frey, median follow-up almost 5 years).
Overall/surgery-related perioperative morbidity was 30%/20% (Frey) and 40%/31% (Beger). In long-term follow-up (Frey vs Beger), 62% vs 50% were completely free of pain, but 6% vs 19% had pain at least once per week or daily, and 32% vs 31% experienced pain attacks at least once per year (n.s.). Diabetes mellitus occured in 60% vs 57% (de novo 34% vs 17%). Rates of exocrine insufficiency were 76% vs. 74% (de novo 34% vs. 33%). Median gain in body weight was 2.5 vs 1.5 kg (n.s.), respectively. Four patients had clinically relevant biliary complications during follow-up requiring reintervention.
Our (nonrandomized) comparison of the long-term outcome after Frey and Beger procedures for chronic pancreatitis reveals a tendency for better pain control with the Frey operation. The functional outcomes were almost identical.
- Buchler MW, Friess H, Muller MW, Wheatley AM, Beger HG. Randomized trial of duodenum-preserving pancreatic head resection versus pylorus-preserving whipple in chronic pancreatitis. Am J Surg 1995;169:65–69; discussion 69-70. CrossRef
- Ceyhan GO, Bergmann F, Kadihasanoglu M, Altintas B, Demir IE, Hinz U, Muller MW, Giese T, Buchler MW, Giese NA, Friess H. Pancreatic neuropathy and neuropathic pain--a comprehensive pathomorphological study of 546 cases. Gastroenterology 2009;136:177–186, e171. CrossRef
- Farkas G, Leindler L, Daroczi M, Farkas G, Jr. Organ-preserving pancreatic head resection in chronic pancreatitis. Br J Surg 2003;90:29–32. CrossRef
- Bockman DE, Buchler M, Malfertheiner P, Beger HG. Analysis of nerves in chronic pancreatitis. Gastroenterology 1988;94:1459–1469.
- Beger HG, Buchler M. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis with inflammatory mass in the head. World J Surg 1990;14:83–87. CrossRef
- Lankisch PG, Lohr-Happe A, Otto J, Creutzfeldt W. Natural course in chronic pancreatitis. Pain, exocrine and endocrine pancreatic insufficiency and prognosis of the disease. Digestion 1993;54:148–155. CrossRef
- Adam U, Makowiec F, Riediger H, Keck T, Kroger JC, Uhrmeister P, Hopt UT. Pancreatic head resection for chronic pancreatitis in patients with extrahepatic generalized portal hypertension. Surgery 2004;135:411–418. CrossRef
- Burgess NA, Scriven MW, Lewis MH. Bleeding pseudocysts and pseudoaneurysms in chronic pancreatitis. Br J Surg 1992;79:182. CrossRef
- Warshaw AL, Jin GL, Ottinger LW. Recognition and clinical implications of mesenteric and portal vein obstruction in chronic pancreatitis. Arch Surg 1987;122:410–415.
- Beger HG, Buchler M, Bittner RR, Oettinger W, Roscher R. Duodenum-preserving resection of the head of the pancreas in severe chronic pancreatitis. Early and late results. Ann Surg 1989;209:273–278. CrossRef
- Frey CF, 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. CrossRef
- Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987;2:701–707. CrossRef
- Strate T, Taherpour Z, Bloechle C, Mann O, Bruhn JP, Schneider C, Kuechler T, Yekebas E, Izbicki JR. Long-term follow-up of a randomized trial comparing the beger and frey procedures for patients suffering from chronic pancreatitis. Ann Surg 2005;241:591–598. CrossRef
- Riediger H, Adam U, Fischer E, Keck T, Pfeffer F, Hopt UT, Makowiec F. Long-term outcome after resection for chronic pancreatitis in 224 patients. J Gastrointest Surg 2007;11:949–959; discussion 959-960. CrossRef
- Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J, Neoptolemos J, Sarr M, Traverso W, Buchler M. Postoperative pancreatic fistula: an international study group (isgpf) definition. Surgery 2005;138:8–13. CrossRef
- Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, Stoker J, Lameris JS, Dijkgraaf MG, Huibregtse K, Bruno MJ. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med 2007;356:676–684. CrossRef
- Keck T, Marjanovic G, Fernandez-del Castillo C, Makowiec F, Schafer AO, Rodriguez JR, Razo O, Hopt UT, Warshaw AL. The inflammatory pancreatic head mass: Significant differences in the anatomic pathology of german and american patients with chronic pancreatitis determine very different surgical strategies. Ann Surg 2009;249:105–110. CrossRef
- Izbicki JR, Bloechle C, Knoefel WT, Rogiers X, Kuechler T. Surgical treatment of chronic pancreatitis and quality of life after operation. Surg Clin North Am 1999;79:913–944. CrossRef
- Beger HG, Witte C, Krautzberger W, Bittner R. Experiences with duodenum-sparing pancreas head resection in chronic pancreatitis. Chirurg 1980;51:303–307.
- Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Soehendra N, Broelsch CE. Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study. Chirurg 1997;68:369–377. CrossRef
- Izbicki JR, Bloechle C, Knoefel WT, Kuechler T, Binmoeller KF, Broelsch CE. Duodenum-preserving resection of the head of the pancreas in chronic pancreatitis. A prospective, randomized trial. Ann Surg 1995;221:350–358. CrossRef
- Beger HG, Schlosser W, Friess HM, Buchler MW. Duodenum-preserving head resection in chronic pancreatitis changes the natural course of the disease: a single-center 26-year experience. Ann Surg 1999;230:512–519; discussion 519-523. CrossRef
- Malka D, Hammel P, Sauvanet A, Rufat P, O'Toole D, Bardet P, Belghiti J, Bernades P, Ruszniewski P, Levy P. Risk factors for diabetes mellitus in chronic pancreatitis. Gastroenterology 2000;119:1324–1332. CrossRef
- Izbicki JR, Bloechle C, Broering DC, Kuechler T, Broelsch CE. Longitudinal v-shaped excision of the ventral pancreas for small duct disease in severe chronic pancreatitis: prospective evaluation of a new surgical procedure. Ann Surg 1998;227:213–219. CrossRef
- Talamini G, Falconi M, Bassi C, Sartori N, Salvia R, Caldiron E, Frulloni L, Di Francesco V, Vaona B, Bovo P, Vantini I, Pederzoli P, Cavallini G. Incidence of cancer in the course of chronic pancreatitis. Am J Gastroenterol 1999;94:1253–1260. CrossRef
- Prinz RA, Greenlee HB. Pancreatic duct drainage in 100 patients with chronic pancreatitis. Ann Surg 1981;194:313–320. CrossRef
- Jordan GL Jr, Strug BS, Crowder WE. Current status of pancreatojejunostomy in the management of chronic pancreatitis. Am J Surg 1977;133:46–51. CrossRef
- White TT, Slavotinek AH. Results of surgical treatment of chronic pancreatitis. Report of 142 cases. Ann Surg 1979;189:217–224. CrossRef
- Widdison AL, Alvarez C, Karanjia ND, Reber HA. Experimental evidence of beneficial effects of ductal decompression in chronic pancreatitis. Endoscopy 1991;23:151–154. CrossRef
- Long-Term Outcome after 92 Duodenum-Preserving Pancreatic Head Resections for Chronic Pancreatitis: Comparison of Beger and Frey Procedures
Journal of Gastrointestinal Surgery
Volume 14, Issue 3 , pp 549-556
- Cover Date
- Print ISSN
- Online ISSN
- Additional Links
- Chronic pancreatitis
- Duodenum-preserving pancreatic head resection
- Long-term outcome
- Pancreatic pain
- Pancreatic endocrine function
- Pancreatic exocrine function
- Industry Sectors
- Author Affiliations
- 1. Department of Surgery, University of Freiburg, Freiburg, Germany
- 2. Department of General and Visceral Surgery, University of Freiburg, Hugstetter Strasse 55, 79106, Freiburg, Germany