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Query: UMLS:C0162473 (Frey)
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Frey's duodenum-preserving resection is one of three techniques of conservative surgery for the relief of pain in chronic calcifying pancreatitis of the pancreatic head described since 1985 [2, 3, 7]. In our view Frey's procedure is the most satisfactory of the three techniques. It does not require transsection of the pancreas and is suitable to deal with ductal stenoses and stones not only in the pancreatic head but also in the body and tail of the pancreas. We have been impressed by the quality of pain relief obtained and by the smoothness of the postoperative course following this operation. Duodenum-preserving resection of the pancreatic head is greatly facilitated by the use of the ultrasonic dissector which permits dissection in a nearly bloodless field and is particularly suitable for achieving decompression of the intrapancreatic part of the common bile duct by dissecting anyway fibrosed and calcified tissue. The techniques of duodenum-preserving resection of the head of the pancreas are based on principles which have stood the test of time. They have, however, been introduced only a few years ago, and their role in the treatment of severe pain associated with chronic pancreatitis yet awaits more precise definition.
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PMID:[The Frey operation: a valuable enrichment of therapeutic possibilities of chronic calcifying pancreatitis]. 159 27

In patients with chronic pancreatitis, common bile duct obstruction is reported in 3.2-45.6% of patients; however, only 5-10% of all patients with chronic pancreatitis require operative decompression of the bile duct. The cause of the intrapancreatic stricture of the common bile duct may be either a fibrotic inflammatory restriction, or compression by a pseudocyst. Obstruction of the duodenum is much less common than common bile duct obstruction in chronic pancreatitis occurring in less than 1-2% of patients with chronic pancreatitis. Colonic obstruction secondary to pancreatitis is very infrequent. The intrapancreatic strictures of chronic pancreatitis are characteristically smooth and tapering on endoscopic retrograde cholangiopancreatography (ERCP), but in some patients, they may have a sharp cut-off and closely resemble the appearance of carcinoma of the pancreas invading the bile duct. The natural history of these intrapancreatic strictures is variable. They may progress and be associated with cholangitis, biliary cirrhosis, common duct stones, or may remain stable for years or regress. Prior pancreaticojejunostomy is not protective against the development of intrapancreatic biliary strictures which may follow in 5-30% of patients, with most authors reporting an incidence of less than 10%. Evaluation of alkaline phosphatase, bilirubin, the presence of jaundice, or the appearance of an intrapancreatic stricture on ERCP is not predictive of whether cholangitis or biliary cirrhosis may or may not develop. The incidence of cholangitis and biliary cirrhosis in patients with intrapancreatic stricture is 9.4% and 7.3%, respectively. Laennec's cirrhosis occurs in a similar number of patients. Operation is indicated in patients with intrapancreatic strictures of the common bile duct in association with chronic pancreatitis in patients developing cholangitis, biliary cirrhosis, common duct stones, progression of the stricture, persistent high elevations of alkaline phosphatase and/or bilirubin for over a month or inability to rule out cancer of the pancreas or periampullary region. The operation of choice is choledochoduodenostomy or Roux-en-Y choledochojejunostomy to bypass the obstructed intrapancreatic portion of the common bile duct. Persistent duodenal obstruction for over 3 or 4 weeks is an indication for gastrojejunostomy. Pain is not a feature of common bile duct obstruction in the absence of cholangitis. In the presence of pain associated with chronic pancreatitis, longitudinal pancreaticojejunostomy is the operation of choice combined with Roux-en-Y choledochojejunostomy. Some of the newer operations, e.g., the Beger and Frey procedures, may make the necessity of a separate operation for biliary decompression superfluous.
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PMID:Treatment of chronic pancreatitis complicated by obstruction of the common bile duct or duodenum. 240 39

Long-term survival (2 to 11 years) in 5 patients who underwent the Beger operation for severe, predominantly cephalic chronic pancreatitis showed that total pain relief has been achieved in all cases, together with weight gain (2 to 18 kg) and return to former occupation. In 3 of the 4 patients who did not have a concomitant biliary derivation, jaundice (2 cases treated by bile duct-duodenum anastomosis) or angiocholitis (1 case) was observed 7, 2 and 3 years after the initial operation. These results are better than with classical exeresis or derivation. The disadvantage of the procedure is that it is technically difficult. In case of a voluminous cystic cavity, the Frey operation should be preferred.
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PMID:[Long-term results of Beger's operation in chronic pancreatitis of cephalic predominance]. 918 3

Drainage and resection are the principles of surgery in chronic pancreatitis. The techniques of duodenum-preserving resection of the head of the pancreas as described by Beger and Frey combine both to different degrees. In a prospective randomized trial both procedures were compared: 74 patients were randomly allocated to either Beger's (n = 38) or Frey's, (n = 36) group. In addition to routine pancreatic diagnostic work-up a multidimensional psychometric quality-of-life questionnaire and a pain score were used. Assessment of endocrine and exocrine function included oral glucose tolerance test, serum concentrations of insulin, C-peptide, and HbA1c, as well as fecal chymotrypsin and pancreolauryl test. The mean interval between symptoms and surgery was 5.1 years (1-12 years). The median follow-up was 30 months. There was no mortality. Overall morbidity was 27% (32% Beger, 22% Frey). Complications from adjacent organs were definitively resolved in 91% (92% Beger, 91% Frey). A decrease in pain score of 95% and 93% after Beger's and Frey's procedure, respectively, and an increase of 67% in the overall quality-of-life index in both groups were observed. Endocrine and exocrine function did not differ between the two groups. Both techniques of duodenum-preserving resection of the head of the pancreas are equally safe and effective with regard to pain relief, improvement of quality of life, and control of complications affecting adjacent organs. Neither procedure leads to further deterioration of endocrine and exocrine pancreatic function.
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PMID:[Drainage versus resection in surgical therapy of chronic pancreatitis of the head of the pancreas: a randomized study]. 920 31

Intraductal and intraparenchymal hypertension represent the rationale for surgical drainage procedures in the treatment of chronic pancreatitis. "Simple" drainage procedures such as longitudinal pancreaticojejunostomy according to Partington-Rochelle have to be distinguished from "extended" drainage operations, e.g. the combination of longitudinal pancreaticojejunostomy with limited local excision of the pancreatic head. This "extended" drainage procedure according to Frey is just as effective as resective procedures in terms of persistent pain relief and definitive management of pancreatitis-associated complications of adjacent organs, i.e. distal common bile duct and duodenal stenosis. This operation also addresses an inflammatory mass in the pancreatic head. In contrast to "simple" drainage procedures the Frey operation allows reliable exclusion of pancreatic carcinoma. With low perioperative morbidity and zero mortality the Frey procedure significantly improves quality of life and leads to social and occupational rehabilitation.
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PMID:[Drainage operation as therapeutic principle of surgical organ saving treatment of chronic pancreatitis]. 941 Jun 73

Chronic pancreatitis (CP) is generally considered as a risk factor for pancreatic adenocarcinoma (PAC). However, the cumulative risk differs among the epidemiological studies. In the individual patient, the differential diagnosis between PAC and CP cannot be always resolved preoperatively and even intraoperatively. In those cases, the uncertainty can only be answered with histological studies of the resected specimen after a radical resection, provided that this type of surgery can be performed with a reasonable risk in a surgically fit patient. The type of resection depends on the location of the suspicious mass. For masses in the tail of the pancreas, a distal pancreatectomy is the procedure of choice. For suspicious lesions in the head of the pancreas, a pancreatoduodenectomy (PD) should be performed. The surgeon and the patient should also acknowledge that a radical resection will occasionally be performed for a suspected malignancy only to find that another etiology (i.e. CP) accounts for the suspicious pancreatic mass. In the presence of a strong suspicion for an underlying malignancy in a patient with head dominant CP, PD should probably be preferred over the newer organ-preserving Beger and Frey procedures, since it is an adequate procedure for both CP and PAC.
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PMID:Pancreatic cancer in patients with chronic pancreatitis: a challenge from a surgical perspective. 1044 29

Between 1991 and 1998 the authors performed 21 pylorus-preserving pancreatoduodenectomies (PPPD), 32 Beger and 13 Frey procedures in chronic pancreatitis with inflammatory head enlargement. The pre- and intraoperative data, as well as the postoperative early and late results were also compared. The preoperative clinical features and the intraoperative morphology were similar in the three groups. Considering the operative and late mortality and the reoperation there was no statistical difference between the procedures. The postoperative hospitalization time was the shortest after the duodenum-preserving pancreatic head resections (Beger and Frey). While the rate of early complications was significantly higher after PPPD, there was no difference in the rate of late complications between the groups. Although each operation gave similarly good late results (freedom from pain, weight gain, exocrine function, quality of life), the condition of the patients was better and the development rate of diabetes was lower (1/27), after Beger procedure, that after PPPD (6/14). Consequently the duodenum-preserving pancreatic head resections seem to be more advantageous, than the PPPD. Nevertheless the latter procedure is the only possibility in some cases.
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PMID:[Comparative study of pancreatic head resection in chronic pancreatitis]. 1053 91

The indications for surgical treatment of chronic pancreatitis are intractable pain or local complications. The purpose of preoperative investigation, apart from establishing the indications for operation, is to select the kind of procedure to be performed. Important factors include narrowing or dilatation of the pancreatic duct and the presence or absence of an inflammatory mass in the pancreas and of pseudocysts. A pylorus preserving pancreatoduodenectomy or duodenum preserving pancreatic head resection is performed in case of an inflammatory mass in the pancreatic head. In limited clinical trials, duodenum-preserving resection was associated with better recovery, this also applies to the Frey procedure, consisting of local resection of the pancreatic head in combination with lateral pancreaticojejunostomy. In case of dilatation of the pancreatic duct (> 8 mm), without an inflammatory mass drainage of the pancreatic ductal system by a lateral pancreaticojejunostomy is appropriate. A pancreatic tail or body resection can be performed for inflammatory lesions confined to the pancreatic tail or body. Symptomatic pseudocysts are drained internally into the stomach, duodenum or a jejunal loop.
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PMID:[Gastrointestinal surgery and gastroenterology. VI. Chronic pancreatitis: surgical aspects]. 1068 19

Surgery for chronic pancreatitis has gained wide acceptance because of excellent results regarding pain alleviation and control of complications arising from adjacent organs. After the introduction of the duodenum preserving pancreatic head resection by Beger almost three decades ago, many modifications have been proposed, evaluated and compared. This article reviews the variety of operations, the reported results and potential advantages. Besides the Beger- and Frey procedure, none of the modifications have been properly evaluated in a prospective randomised trial. Both procedures managed to relief the outlined problems while achieving low operative mortality and morbidity. Only the operations according to Beger and Frey can be considered standard procedures in chronic Pancreatitis.
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PMID:Modifications of the duodenum-preserving pancreatic head resection. 1082 27

For the period from 1992 to 1998 years 554 patients with complicated chronic pancreatitis were operated on. In 248 patients the longitudinal pancreatojejunostomy was performed, in 113--pancreatojejunostomy in 75--external drainage of the cyst, of them in 12--under the ultrasonic investigation control. In 21 patients pancreatoduodenal resection was conducted, pancreatic gland (PG) distal resection--in 41. In 4 patients with the PG head calcinosis the pancreatic resection according to Beger was done, in 3--the Frey operation. In the total PG calcinosis in 9 patients the modified Frey's operation was performed in conjunction with platitude PG resection along posterior wall of her duct. The indirect operation on PG were done in 40 patients. Nine (1.6%) of patients died.
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PMID:[Surgical strategies in the treatment of complicated forms of chronic pancreatitis]. 1085 9


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