Feasibility and safety of laparoscopic Frey’s procedure for chronic pancreatitis_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

XIA Qi ^1,2 , CAI He ^1,2 , WANG Xin ^1,2 , WU Zhong ^1,2 , GAO Pan ^1,2 ,  CAI Yunqiang ^1,2 , PENG Bing ^1,2

1. Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu 610041, P. R. China;
2. West China School of Medicine/West China Hospital of Sichuan University, Chengdu 610041, P. R. China;

Corresponding author：

CAI Yunqiang, Email: pengbing84@hotmail.com

Keywords：

chronic pancreatitis; Frey operation; laparoscopy; feasibility; safety

DOI：

10.7507/1007-9424.202307049

Video：

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Objective To explore the feasibility and safety of Frey operation under laparoscopy in the treatment of chronic pancreatitis. Methods The clinical data of chronic pancreatitis patients who underwent laparoscopic Frey procedure in Division of Pancreatic Surgery, Department of General Surgery, West China Hospital, Sichuan University from 2021-2023 were retrospectively analyzed. Results Eleven patients with chronic pancreatitis complicated with pancreatic duct stones were included in the study, 7 of whom had a history of diabetes and (or ) impaired glucose tolerance, suggesting that pancreatic endocrine function was impaired. The median diameter of the main pancreatic duct measured by imaging method was 8 mm (4–20mm). The median operative time was 188 min (120–368 minutes), and the total intraoperative bleeding volume was 50 mL (20–100 mL). Postoperative pancreatic fistula did not occur, one case of postoperative abdominal fluid accumulation and hypoproteinemia improved after symptomatic supportive treatment such as anti infection, acid and enzyme inhibition, and nutritional rehydration. Postoperative bleeding occurred in 3 cases, including 1 case of intestinal anastomotic bleeding, which was sutured again under emergency laparoscopic intestinal anastomosis to stop bleeding. The other two cases improved after conservative management such as blood transfusion, plasma, vitamin K, acid inhibition, enzyme inhibition and hemostatic drugs. The median postoperative hospitalization time was 7 days (4–18 days), and no patient mortality happened within 90 days after surgery. Conclusion Laparoscopic Frey operation is feasible and a relatively safe and effective method for the treatment of chronic pancreatitis.

Citation： XIA Qi, CAI He, WANG Xin, WU Zhong, GAO Pan, CAI Yunqiang, PENG Bing. Feasibility and safety of laparoscopic Frey’s procedure for chronic pancreatitis. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2023, 30(9): 1042-1046. doi: 10.7507/1007-9424.202307049 Copy

1.	Gestic MA, Callejas-Neto F, Chaim EA, et al. Surgical treatment of chronic pancreatitis using Frey’s procedure: a Brazilian 16-year single-centre experience. HPB (Oxford), 2011, 13(4): 263-271.
2.	Kempeneers MA, van Hemert AKE, van der Hoek M, et al. Short- and long-term outcomes of selective use of Frey or extended lateral pancreaticojejunostomy in chronic pancreatitis. Br J Surg, 2022, 109(4): 363-371.
3.	Ray S, Dhali A, Ansari Z, et al. Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis. Am J Surg, 2023, 225(4): 709-714.
4.	高雅南, 王宾, 张忠涛. Frey术式与Whipple术式治疗慢性胰腺炎患者疼痛及生活质量改善的对比研究. 临床和实验医学杂志, 2019, 18(17): 1870-1874.
5.	Nakajima T, Fukumoto T, Tsukamoto T, et al. Laparoscopic Frey’s procedure for chronic pancreatitis in a Japanese patient. Am J Case Rep, 2020, 21: e924206.
6.	Ray S, Basu C, Dhali A, et al. Frey procedure for chronic pancreatitis: A narrative review. Ann Med Surg (Lond), 2022, 80: 104229.
7.	Gardner TB, Adler DG, Forsmark CE, et al. ACG Clinical Guideline: chronic pancreatitis. Am J Gastroenterol, 2020, 115(3): 322-339.
8.	Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA, 2019, 322(24): 2422-2434.
9.	Bouwense SAW, Kempeneers MA, van Santvoort HC, et al. Surgery in chronic pancreatitis: indication, timing and procedures. Visc Med, 2019, 35(2): 110-118.
10.	Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
11.	Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558.
12.	Jawad ZAR, Kyriakides C, Pai M, et al. Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis. Asian J Surg, 2017, 40(3): 179-185.
13.	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(4): 350-358.
14.	Fernández-Cruz L, Sáenz A, Astudillo E, et al. Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc, 2002, 16(6): 996-1003.
15.	曾新桃, 杨培, 罗华, 等. 腹腔镜手术在慢性胰腺炎治疗中的应用. 中国普外基础与临床杂志, 2022, 29(10): 1355-1358.
16.	Nag HH, Nekarakanti PK, Arvinda PS, et al. Laparoscopic versus open surgical management of patients with chronic pancreatitis: Amatched case-control study. J Minim Access Surg, 2022, 18(2): 191-196.
17.	Pessaux P, Kianmanesh R, Regimbeau JM, et al. Frey procedure in the treatment of chronic pancreatitis: short-term results. Pancreas, 2006, 33(4): 354-358.
18.	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(4): 492-504.
19.	Chaudhary A, Negi SS, Masood S, et al. Complications after Frey’s procedure for chronic pancreatitis. Am J Surg, 2004, 188(3): 277-281.
20.	杜奕奇, 宋英晓. 胰源性门静脉高压的诊断与处理. 中华消化杂志, 2020, 40(7): 450-453.
21.	Lakshmanan A, Ravichandran P, Jeswanth S, et al. Bleeding complication after pancreatic surgery: role of harmonic scalpel. Indian J Surg, 2013, 75(Suppl 1): 436-438.

1. Gestic MA, Callejas-Neto F, Chaim EA, et al. Surgical treatment of chronic pancreatitis using Frey’s procedure: a Brazilian 16-year single-centre experience. HPB (Oxford), 2011, 13(4): 263-271.
2. Kempeneers MA, van Hemert AKE, van der Hoek M, et al. Short- and long-term outcomes of selective use of Frey or extended lateral pancreaticojejunostomy in chronic pancreatitis. Br J Surg, 2022, 109(4): 363-371.
3. Ray S, Dhali A, Ansari Z, et al. Predictors of 90-day morbidity and mortality after Frey procedure for chronic pancreatitis. Am J Surg, 2023, 225(4): 709-714.
4. 高雅南, 王宾, 张忠涛. Frey术式与Whipple术式治疗慢性胰腺炎患者疼痛及生活质量改善的对比研究. 临床和实验医学杂志, 2019, 18(17): 1870-1874.
5. Nakajima T, Fukumoto T, Tsukamoto T, et al. Laparoscopic Frey’s procedure for chronic pancreatitis in a Japanese patient. Am J Case Rep, 2020, 21: e924206.
6. Ray S, Basu C, Dhali A, et al. Frey procedure for chronic pancreatitis: A narrative review. Ann Med Surg (Lond), 2022, 80: 104229.
7. Gardner TB, Adler DG, Forsmark CE, et al. ACG Clinical Guideline: chronic pancreatitis. Am J Gastroenterol, 2020, 115(3): 322-339.
8. Singh VK, Yadav D, Garg PK. Diagnosis and management of chronic pancreatitis: a review. JAMA, 2019, 322(24): 2422-2434.
9. Bouwense SAW, Kempeneers MA, van Santvoort HC, et al. Surgery in chronic pancreatitis: indication, timing and procedures. Visc Med, 2019, 35(2): 110-118.
10. Cahen DL, Gouma DJ, Nio Y, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med, 2007, 356(7): 676-684.
11. Díte P, Ruzicka M, Zboril V, et al. A prospective, randomized trial comparing endoscopic and surgical therapy for chronic pancreatitis. Endoscopy, 2003, 35(7): 553-558.
12. Jawad ZAR, Kyriakides C, Pai M, et al. Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis. Asian J Surg, 2017, 40(3): 179-185.
13. 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(4): 350-358.
14. Fernández-Cruz L, Sáenz A, Astudillo E, et al. Laparoscopic pancreatic surgery in patients with chronic pancreatitis. Surg Endosc, 2002, 16(6): 996-1003.
15. 曾新桃, 杨培, 罗华, 等. 腹腔镜手术在慢性胰腺炎治疗中的应用. 中国普外基础与临床杂志, 2022, 29(10): 1355-1358.
16. Nag HH, Nekarakanti PK, Arvinda PS, et al. Laparoscopic versus open surgical management of patients with chronic pancreatitis: Amatched case-control study. J Minim Access Surg, 2022, 18(2): 191-196.
17. Pessaux P, Kianmanesh R, Regimbeau JM, et al. Frey procedure in the treatment of chronic pancreatitis: short-term results. Pancreas, 2006, 33(4): 354-358.
18. 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(4): 492-504.
19. Chaudhary A, Negi SS, Masood S, et al. Complications after Frey’s procedure for chronic pancreatitis. Am J Surg, 2004, 188(3): 277-281.
20. 杜奕奇, 宋英晓. 胰源性门静脉高压的诊断与处理. 中华消化杂志, 2020, 40(7): 450-453.
21. Lakshmanan A, Ravichandran P, Jeswanth S, et al. Bleeding complication after pancreatic surgery: role of harmonic scalpel. Indian J Surg, 2013, 75(Suppl 1): 436-438.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Feasibility and safety of laparoscopic Frey’s procedure for chronic pancreatitis

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