Assessment of Frey procedures: Japanese experience.
OBJECTIVE
The Frey procedure, the coring out of the pancreatic head and longitudinal pancreaticojejunostomy, is a safe, easy, and reliable method to solve most of the problems associated with chronic pancreatitis. During long-term follow up, unexpected relapse in the pancreatic tail was encountered. The pattern of failure and the rationale for a new procedure to treat or prevent such relapse were investigated.


METHODS
From 1992 to 2008, 71 patients with chronic pancreatitis underwent the Frey procedure at Tohoku University Hospital. The etiology was alcoholic in 92.6% of them, followed in incidence by idiopathic and hereditary chronic pancreatitis. In the primary operation, besides the Frey procedure, combined resection of the pancreatic tail was performed in three patients, and choledochoduodenostomy was performed in one patient. The follow-up rate was 92.9%, with a median period of 46 months.


RESULTS
The incidence of early postoperative complications was 18.4%, with one reoperation for gastrointestinal bleeding from the splenic artery. Pain control was achieved in all patients and there was no operative mortality. During the long-term follow up of 62 patients with the Frey procedure, eight patients had relapse of inflammation and required reoperation. Five of these eight patients had a pseudocyst in the pancreatic tail and underwent distal pancreatectomy (DP).


CONCLUSIONS
Relapse occurred in alcoholic middle-aged male patients, and in the patients with hereditary and idiopathic pancreatitis. Frey-DP and Frey-spleen-preserving DP (SPDP) procedures can be performed safely and effectively to treat the relapse and to prevent relapse in the pancreatic tail.
Division of Hepato-Biliary-Pancreatic Surgery, Tohoku University Graduate School of Medicine, Seiryo Aoba, Sendai, 980-8574, Japan. egawas@surg1.med.tohoku.ac.jp
Shinichi
S
Egawa
Fuyuhiko
F
Motoi
Naoaki
N
Sakata
Yo
Y
Kitamura
Kei
K
Nakagawa
Hideo
H
Ohtsuka
Hiroki
H
Hayashi
Takanori
T
Morikawa
Noriyuki
N
Omura
Shigeru
S
Ottomo
Hiroshi
H
Yoshida
Toru
T
Onogawa
Kuniharu
K
Yamamoto
Masanori
M
Akada
Toshiki
T
Rikiyama
Yu
Y
Katayose
Seiki
S
Matsuno
Michiaki
M
Unno
D000293:Adolescent; D000328:Adult; D000368:Aged; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010193:Pancreaticojejunostomy / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D055502:Secondary Prevention; D013997:Time Factors; D055815:Young Adult