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Query: UMLS:C0162473 (Frey)
 2,599 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Initial management of chronic pancreatitis is always conservative. All forms of nonsurgical intervention should be exhausted before surgery. Main indications for surgery in chronic pancreatitis are intractable pain, suspicion of malignancy, and complications from adjacent organs. Preoperative evaluation should include an evaluation of the severity of pain, interference of quality of life, and presence of chemical dependency and imaging examinations to determine the primary site of disease, presence of pancreatic ductal dilatation, and associated peripancreatic complications. The surgical treatment approach involves proximal or distal resection (depending on the main location of the disease) for small-duct disease and lateral pancreaticojejunal drainage for large-duct disease. The newer duodenum-preserving head resections of Beger and Frey and thoracoscopic transthoracic splanchnicectomy await good confirmatory, independent trials to confirm their efficiency in the surgical management of chronic pancreatitis. The V-shaped excision of ventral pancreas in association with a lateral pancreatojejunostomy is also an interesting alternative in the management of small-duct disease that is also under investigation. In recent years, a clear trend in favor of resectional procedures (including the newer nonanatomic pancreatic resections) has been observed.
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PMID:Surgical management of chronic pancreatitis: current concepts and future perspectives. 1471 27

Chronic pancreatitis is an inflammatory disease characterized by the progressive conversion of pancreatic parenchyma to fibrous tissue. The most frequent causes are alcohol overconsumption and anatomic variants such as pancreas divisum, cholelithiasis, and individual genetic predisposition. The process of fibrosis with consecutive loss of pancreatic parenchyma leads to exocrine insufficiency and maldigestion and, in advanced stages of the disease, to diabetes mellitus. Beside exocrine and endocrine malfunction, mechanical complications occur such as the formation of pancreatic pseudocysts and duodenal and common bile duct obstruction. About 50% of patients with chronic pancreatitis need surgical intervention due to untreatable chronic pain. As recent investigations suggest that the head of the pancreas triggers the chronic inflammatory process, resection of this inflammatory mass must be regarded as pivotal in any surgical intervention. Radical techniques such as the Whipple procedure are undoubtedly successful regarding pain reduction but, even in its pylorus-preserving variant, associated with high postoperative morbidity due to a large loss of pancreatic parenchyma and the absence of duodenal passage. Thirty years ago, H.G. Beger described for the first time the technique of duodenum-preserving pancreatectomy, which better combines resection of the pancreatic head with low morbidity. Over the years, different variations of the original Beger technique (Frey, Izbicky, Berne modification) have been developed, and the excellent results obtained with these methods underline that organ-sparing techniques should be preferred in the surgical treatment of chronic pancreatitis.
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PMID:[Duodenum-preserving pancreas head resection-an operative technique for retaining the organ in the treatment of chronic pancreatitis]. 1500 27

We report the occurrence of inadvertent injury to the intra-pancreatic common bile duct in 3 of 9 patients undergoing Frey's procedure for chronic pancreatitis with inflammatory mass in the head. In one case, the choledochotomy was extended and anastomosed to the cored-out parenchyma. In the other two, after lateral pancreatico-jejunostomy, hepatico-jejunostomy was performed using the same Roux loop.
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PMID:Inadvertent choledochotomy during Frey's procedure: management options. 1503 36

Mutations in the cationic trypsinogen gene are acknowledged as a risk factor for pancreatic cancer in patients with hereditary pancreatitis. However, whether patients with mutations in other genes, such as the serine protease inhibitor Kazal type 1 (SPINK1) gene, are also at a higher risk of pancreatic cancer remains unknown. We report a case of pancreatic cancer associated with chronic calcifying pancreatitis in a patient with a homozygous N34S mutation in the SPINK1 gene. A 44-year-old woman was hospitalized due to obstructive jaundice. Preoperative examination showed a tumor in the head of the pancreas and multiple pancreatic stones; pancreatoduodenectomy revealed a solid tumor, 3.0 x 2.5 cm in size, in the head of the pancreas, and numerous pancreatic stones throughout the pancreas. Pathologic studies revealed moderately differentiated tubular adenocarcinoma. Mutational analyses of the SPINK1 and PRSS1 genes in members of the patient's family were carried out. The homozygous N34S mutation in the SPINK1 gene was found in the patient and her older sister, who was previously diagnosed with chronic calcific pancreatitis and had undergone the Frey operation. The patient's parents and brother were unaffected carriers of the N34S heterozygous mutation. No family members had any mutations in the cationic trypsinogen gene. To our knowledge, this is the first reported case of chronic pancreatitis accompanied by pancreatic cancer in a patient with the SPINK1 N34S mutation. Although this case does not meet the classic criteria of hereditary pancreatitis, it does suggest that the SPINK1 N34S mutation may be associated with cancer development in patients with hereditary pancreatitis. Further prospective, multicenter trials investigating secondary screening for pancreatic cancer in hereditary pancreatitis are necessary to clarify the role of SPINK1 mutations in the development of pancreatic cancer.
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PMID:Hereditary pancreatitis as the premalignant disease: a Japanese case of pancreatic cancer involving the SPINK1 gene mutation N34S. 1508 77

The "golden standard" of the surgical treatment of chronic pancreatitis with an inflammatory mass in the head of the pancreas seems to be the duodenum preserving resection of the head of the pancreas as described by Beger. However, in some cases, the inflammatory process may induce an encasement of the retropancreatic intestinal vessels making the dissection of the portal vein very difficult. The local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy (Frey operation) was developed in order to provide a simple and less time consuming procedure, that avoids the dissection of the portal vein and is especially indicated in cases with severe inflammatory and edematous alterations of the head of the pancreas at this level and with dilated pancreatic duct. Two patients with chronic pancreatitis with severe pain, addiction to analgesics and weight loss underwent a Frey procedure. In both patients an inflammatory mass in the head of the pancreas and dilated pancreatic duct were demonstrated. The freeing of the head of the pancreas from the portal vein was not possible because of the intense inflammatory process. The local resection of the pancreatic head and the longitudinal pancreatico-jejunostomy was successfully performed. There were no postoperative mortality or morbidity and the short and long term results (pain relief and nutritional status) are excellent.
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PMID:[Frey operation--valuable alternative in the surgical treatment of chronic pancreatitis]. 1527 51

The management of patients with chronic pancreatitis (CP) remains a challenging problem. Main indications for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The main goal of surgical treatment is improvement of patient quality of life. The surgical treatment approach usually involves proximal pancreatic resection, but lateral pancreaticojejunal drainage may be used for large-duct disease. The newer duodenum-preserving head resections of Beger and Frey provide good pain control and preservation of pancreatic function. Thoracoscopic splanchnicectomy and the endoscopic approach await confirmatory trials to confirm their efficiency in the management of CP. Common bile duct obstruction is addressed by distal Roux-en-Y choledochojejunostomy but when combined with dudodenal obstruction must be treated by pancreatic head resection. Pancreatic ascites due to disrupted pancreatic duct should be treated by internal drainage. The approach to CP is multidisciplinary, tailoring the various therapeutic options to meet each individual patient's needs.
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PMID:Surgical and interventional treatment of chronic pancreatitis. 1548 50

Chronic pancreatitis is an inflammatory disease which is characterized by a progressive conversion of pancreatic parenchyma into fibrous tissue. Most frequent causes are alcohol over-consumption, beside anatomic variants such as pancreas divisum, cholelithiasis or individual genetic predisposition. The process of fibrotic transformation with consecutive loss of pancreatic parenchyma leads to exocrine insufficiency and maldigestion, and in advanced stage of the disease to diabetes mellitus. In addition to exocrine and endocrine malfunction, mechanical complications such as formation of pancreatic pseudocysts, duodenal and common bile duct obstruction occur. About 50% of the patients with chronic pancreatitis will need surgical intervention due to intractable chronic pain. Recent investigations suggest that the head of the pancreas triggers the chronic inflammatory process. Therefore, resection of this inflammatory mass must be regarded as the pivotal part of any surgical intervention. Radical techniques such as Whipple-procedure are undoubtedly successful regarding pain reduction. However, even in its pylorus preserving variant this technique is associated with a high postoperative morbidity due to large loss of pancreatic parenchyma and the loss of the duodenal passage. 30 years ago, H. G. Beger described for the first time the technique of duodenum preserving pancreatic head resection that better combines resection of the pancreatic head with low morbidity. Over the years different variations of the original Beger technique (Frey, Izbicky, Berne modification) have been developed, and the excellent results obtained with these techniques underline, that organ sparing procedures should be preferred in the surgical treatment of chronic pancreatitis.
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PMID:Duodenum preserving pancreatic head resection in the treatment of chronic pancreatitis. 1563 14

Frey's procedure, which is performed for chronic pancreatitis, principally involves coring of the head of the pancreas and pancreaticojejunostomy. The coring of the inflamed and enlarged pancreatic head is the most difficult and time-consuming part of this operation and is often associated with considerable bleeding. We used the harmonic scalpel to perform Frey's procedure in six consecutive patients, which reduced intraoperative bleeding and made the operation technically easier.
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PMID:Frey's procedure using the harmonic scalpel. 1577 3

In 49 patients with an acute pancreatitis and 91 - with chronic pancreatitis were studied external and internal secretory pancreatic function in remote terms after the treatment. In 48 (52.7%) patients, suffering chronic pancreatitis, the investigated indexes were studied in dynamic before and after the operation. There was established the disorders of external secretory pancreatic function in an acute pancreatitis of severe stage and noninfected pancreonecrosis in patients, to whom direct operative pancreatic interventions were not performed. Indications for conduction of internal drainage of the pancreatic ducts, taking into account data of preoperative instrumental examination and initial activity of fecal elastase-1, were substantiated. The advantages of Beger and Frey operations, in comparison with resecting procedures, were proved because of lesser occurrence of the pancreatic functions disorders.
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PMID:[Change of external and internal secretory pancreatic function in pancreatitis]. 1650 79

Only limited prospective data are available regarding the long-term outcome of local resection of the pancreatic head in combination with longitudinal pancreaticojejunostomy in patients with chronic pancreatitis. From 1997 to 2001, 40 patients affected by chronic pancreatitis were subjected to the Frey's procedure. Preoperative selection criteria included confirmed diagnosis of chronic pancreatitis, dilation of Wirsung's duct to a diameter greater than 6 mm, and the absence of obstructive chronic pancreatitis secondary to fibrotic stenosis at the pancreatic body or tail. Preoperative pain was present in 38 cases (95%), and follow-up was performed in all patients at least once yearly up to 2003 (median 60 months, inter percentile range 20.1-79.6). Postoperative morbidity occurred in three cases (7.5%). The percentage of pain-free patients was 94.7%, 93.7%, 87.5%, and 90% at 1, 2, 3, and 4/5 years after surgical operation, respectively. After surgery, three patients developed diabetes. Both the body mass index and quality of life showed statistically significant improvements at all follow-up intervals. Whenever surgery is indicated, the short-term and long-term outcomes confirm that Frey's procedure is an appropriate means of management for patients with chronic pancreatitis in the absence of doubts of neoplasia and/or distal ductal obstruction.
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PMID:Long-term results of Frey's procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. 1662 15


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