Skip to main content

Advertisement

SpringerLink
Log in

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

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Andren-Sandberg A, Hoem D, Gislason H. Pain management in chronic pancreatitis. Eur J Gastroenterol Hepatol 2002; 14:957–70.

    Article  PubMed  Google Scholar 

  2. Tsiotou AG, Sakorafas GH. Pathophysiology of pain in chronic pancreatitis. Clinical implications from a surgical perspective. Int Surg 2000; 85:291–6.

    PubMed  CAS  Google Scholar 

  3. Coffey R. Pancreaticoenterostomy and pancreatectomy. Ann Surg 1909; 50:1238–64

    Article  PubMed  CAS  Google Scholar 

  4. Andersen DK, Frey CF. The evolution of the surgical treatment of chronic pancreatitis. Ann Surg 2010; 251(1): 18–32.

    Article  PubMed  Google Scholar 

  5. Puestow CB, Gillesby WJ. Retrograde surgical drainage of pancreas for chronic relapsing pancreatitis. AMA Arch Surg 1958; 76:898–907.

    Article  PubMed  CAS  Google Scholar 

  6. Gourgiotis S, Germanos S, Ridolfini MP. Surgical management of chronic pancreatitis. Hepatobiliary Pancreat Dis Int 2007; 6:121–33.

    PubMed  Google Scholar 

  7. Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas 1987; 2:701–7.

    Article  PubMed  CAS  Google Scholar 

  8. Ho HS, Frey CF. The Frey procedure. Local resection of pancreatic head combined with lateral pancreaticojejunostomy. Arch Surg 2001; 136:1333–8.

    Article  Google Scholar 

  9. Pessaux P, Kianmanesh R, Regimbeau JM et al. Frey procedure in the treatment of chronic pancreatitis short-term results. Pancreas 2006; 33:354–8.

    Article  PubMed  Google Scholar 

  10. 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.

    Article  PubMed  CAS  Google Scholar 

  11. 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.

    Article  PubMed  Google Scholar 

  12. 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.

    Article  PubMed  Google Scholar 

  13. 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.

    Article  PubMed  Google Scholar 

  14. 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.

    Article  PubMed  Google Scholar 

  15. 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  CAS  Google Scholar 

  16. Schnelldorfer T., Adams D.B. Surgical treatment of alcohol-associated chronic pancreatitis: the challenges and pitfalls. Am Surg 2008;74(6):503–7.

    PubMed  Google Scholar 

  17. 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.

    Article  PubMed  CAS  Google Scholar 

  18. Frey CF, Reber HA. How I do it? J Gastrointest Surg 2005; 9:863–8.

    Article  PubMed  Google Scholar 

  19. WHO/ADA. Report of the expert committee on the diagnosis and classification of diabetes mellitus. Diabetes Care 1997; 20:1183–97.

    Google Scholar 

  20. Cancer pain relief guidelines. 1st edition. World Health Organization, Geneva, Switzerland 1986. The WHO analgesic ladder.

  21. 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.

    Article  PubMed  Google Scholar 

  22. 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.

    Article  PubMed  Google Scholar 

  23. 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.

    Article  PubMed  Google Scholar 

  24. 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. 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.

    Article  PubMed  Google Scholar 

  26. 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.

    Article  PubMed  CAS  Google Scholar 

  27. Chaudhary A, Negi SS, Massod S, et al. Complications after Frey’s procedure for chronic pancreatitis. IS J Surg. 2004; 188:277–81.

    Google Scholar 

  28. 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.

    Article  PubMed  CAS  Google Scholar 

  29. Schnelldorfer T, Lewin DN, Adams DB. Do preoperative pancreatic stents increase operative morbidity for chronic pancreatitis? Hepatogastroenterology 2005; 52:1878–82.

    PubMed  Google Scholar 

  30. Partington PF, Rochelle RE. Modified Puestow procedure for retrograde drainage of the pancreatic duct. Ann Surg 1960; 152:1037–43.

    Article  PubMed  CAS  Google Scholar 

  31. 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  CAS  Google Scholar 

  32. Frey CF. The surgical management of chronic pancreatitis: The Frey procedure. Adv Surg 1999; 32: 41–85.

    PubMed  CAS  Google Scholar 

  33. Shrikhande SV, Kleeff J, Friess H, Büchler MW. Management of pain in small duct chronic pancreatitis. J Gastrointest Surg 2006; 10(2): 227–33.

    Article  PubMed  Google Scholar 

  34. 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.

    Article  PubMed  CAS  Google Scholar 

  35. 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.

    Article  PubMed  CAS  Google Scholar 

  36. 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.

    Article  PubMed  Google Scholar 

  37. 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.

    Article  PubMed  CAS  Google Scholar 

  38. 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.

    Article  PubMed  Google Scholar 

  39. 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.

    Article  PubMed  Google Scholar 

  40. Braganza JM, Lee SH, McCloy RF, McMahon MJ. Chronic pancreatitis. Lancet 2011; 377:1184–97.

    Article  PubMed  CAS  Google Scholar 

  41. 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.

    Article  Google Scholar 

  42. Hartel M, Tempia-Caliera AA, Wente MN, et al. Evidence-based surgery in chronic pancreatitis. Langenbecks Arch Surg. 2003; 388:132–9.

    PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Digestive Surgery, University Hospital, 4 rue Larrey, 49933, Angers, France

    Alexandra M. D. Roch, Dorothée Brachet, Emilie Lermite & Jean-Pierre Arnaud

  2. Department of General Surgery, Hôpital de Hautepierre, Avenue Molière, 67098, Strasbourg, France

    Patrick Pessaux

Authors
  1. Alexandra M. D. Roch
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Dorothée Brachet
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Emilie Lermite
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Patrick Pessaux
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jean-Pierre Arnaud
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Alexandra M. D. Roch.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Roch, A.M.D., Brachet, D., Lermite, E. et al. Frey Procedure in Patients with Chronic Pancreatitis: Short and Long-term Outcome from a Prospective Study. J Gastrointest Surg 16, 1362–1369 (2012). https://doi.org/10.1007/s11605-012-1904-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s11605-012-1904-8

Keywords

Search

Navigation