title: Long-term outcomes after Frey's procedure for chronic pancreatitis with an inflammatory mass of the pancreatic head, with special reference to locoregional complications.
abstract: BACKGROUND
  Frey's procedure might be a good alternative to pylorus-preserving pancreaticoduodenectomy (PPPD) for patients with an inflammatory mass of the head of the pancreas, because it is technically easy and associated with low morbidity and good pain relief.
  
  
  OBJECTIVE
  To analyze the short-term and long-term outcomes of Frey's procedure in comparison with PPPD and to evaluate the efficacy of Frey's procedure against preoperative locoregional complications.
  
  
  METHODS
  From August 1997 through December 2007, 6 patients underwent Frey's procedure (as described by Frey and Smith), and 10 patients underwent PPPD. The mean follow-up times were 70.8 months (Frey's procedure) and 119.8 months (PPPD). Preoperative biliary stricture and duodenal stenosis were observed in 4 and 3 patients, respectively, of patients undergoing Frey's procedure. Pain intensity was assessed with a pain scoring system. Quality of life (QOL) was assessed with the European Organization for Research and Treatment of Cancer Quality of-Life Questionnaire-Core 30. Exocrine and endocrine pancreatic function was measured during follow-up.
  
  
  RESULTS
  Significant reductions in total pain scores and all QOL scale scores were observed immediately after surgery in all patients (P<0.05). Frey's procedure was superior to PPPD with regard to physical status 7 years after surgery (P<0.05). One patient in the Frey group had a grade B pancreatic fistula, and 2 patients in the PPPD group had intra-abdominal bleeding and delayed gastric emptying. There were no re-operations or surgery-related deaths in either group. Diabetes developed postoperatively in 2 patients in the PPPD group. No patients with preoperative duodenal or biliary stricture or both had a relapse. Three patients in the PPPD group died during follow-up of diseases unrelated to chronic pancreatitis.
  
  
  CONCLUSIONS
  Frey's procedure is safe and effective with regard to pain relief, preservation of pancreatic function, and improvement of QOL over the long term. Moreover, this procedure can also be used to treat preoperative biliary stricture and duodenal stenosis associated with an inflammatory mass of the pancreatic head.
authors: Department of Surgery, Nippon Medical School, Tokyo, Japan. aimoto@nms.ac.jp
authors: Takayuki
authors: T
authors: Aimoto
authors: Eiji
authors: E
authors: Uchida
authors: Akira
authors: A
authors: Matsushita
authors: Yoichi
authors: Y
authors: Kawano
authors: Satoshi
authors: S
authors: Mizutani
authors: Tadashi
authors: T
authors: Kobayashi
mesh_terms: D013505:Digestive System Surgical Procedures / Q000009:adverse effects*; D006801:Humans; D007249:Inflammation / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010179:Pancreas / Q000503:physiopathology / Q000601:surgery*; D050500:Pancreatitis, Chronic / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology*; D011788:Quality of Life; D013997:Time Factors; D016896:Treatment Outcome