Short- and long-term outcomes of selective use of Frey or extended lateral pancreaticojejunostomy in chronic pancreatitis

Kempeneers, M.A.; Hemert, A.K.E. van; Hoek, M. van der; Issa, Y.; Hooft, J.E. van; Nio, C.Y.; ... ; Boermeester, M.A. (2022)

Article / Letter to editor

Background Surgery is the most effective treatment in patients with painful chronic pancreatitis and a dilated pancreatic duct. Studies reporting the outcomes of selected surgical approach according to the pancreatic head size in these patients are lacking. Method This was a retrospective, observational single-centre study of consecutive patients who underwent either a Frey procedure or extended lateral pancreaticojejunostomy (eLPJ) for pain due to chronic pancreatitis with a dilated main pancreatic duct (5 mm or more) between 2006 and 2017. A Frey procedure was used in patients with pancreatic head enlargement (40 mm or more) and eLPJ (full-length pancreaticojejunostomy, including transection of the gastroduodenal artery) in others. A biliodigestive bypass was added in the case of biliary obstruction. Results Overall, 140 of 220 patients met the eligibility criteria: 70 underwent a Frey procedure and 70 an eLPJ. Hepaticojejunostomy was added in 17.1 per cent of patients (Frey: 24.3 per cent; eLPJ: 10.0 per cent (P = 0.025)). Major morbidity occurred in 15.0 per cent of patients (Frey: 21.4 per cent; eLPJ: 8.6 per cent (P = 0.033)). After a median 7.8 years of follow-up, the mean (s.d.) decrease in Izbicki pain score was 33 (27) points (34 (28) points after a Frey procedure; 32 (26) points after an eLPJ). Pain relief was reported as 'very much' by 87.5 per cent of patients (Frey: 86.1 per cent; eLPJ: 88.9 per cent) and as 'partial' by 11.1 per cent (Frey: 13.8 per cent; eLPJ: 8.3 per cent). Conclusion Selective-use of either a Frey procedure or eLPJ in patients with symptomatic chronic pancreatitis was-associated with low morbidity and long-term pain relief. Adding a-biliodigestive bypass did not increase morbidity.Studies reporting on short- and long-term outcomes of Frey and extended lateral pancreaticojejunostomy (eLPJ) in chronic pancreatitis are lacking. In 140 consecutive patients the rate of major morbidity was 15 per cent (Frey: 21 per cent; eLPJ: 9 per cent). After median follow-up of 7.8 years in 75 patients, mean (s.d.) decrease in Izbicki pain score was 33 (27) points (Frey: 34 (28); eLPJ: 32 (26)) and pain relief was reported as 'very much' by 88 per cent of patients (Frey: 86 per cent; eLPJ: 89 per cent).

• All authors: Kempeneers, M.A.; Hemert, A.K.E. van; Hoek, M. van der; Issa, Y.; Hooft, J.E. van; Nio, C.Y.; Busch, O.R.; Santvoort, H.C. van; Besselink, M.G.; Boermeester, M.A.
• Date: 2022-03-15
• Journal: British Journal of Surgery
• Volume: 109
• Issue: 4
• Pages: 363 - 371
• DOI: doi:10.1093/bjs/znab473
• Link: https://academic.oup.com/bjs/article/109/4/363/6522949