title: Frey procedure for the treatment of chronic pancreatitis associated with common bile duct stricture.
abstract: BACKGROUND
  The Frey procedure (FP) is the treatment of choice for symptomatic chronic pancreatitis (CP). In cases of biliary stricture, biliary derivation can be performed by choledochoduodenostomy, Roux-en-Y choledochojejunostomy or, more recently, reinsertion of the common bile duct (CBD) into the resection cavity. The objective of the present study was to evaluate the outcomes associated with each of these three types of biliary derivation.
  
  
  METHODS
  We retrospectively analyzed demographic, CP-related, surgical and follow-up data for patients having undergone FP for CP with biliary derivation between 2004 and 2012 in our university medical center. The primary efficacy endpoint was the rate of CBD stricture recurrence. The secondary endpoints were surgical parameters, postoperative complications, postoperative follow-up and the presence of risk factors for secondary CBD stricture.
  
  
  RESULTS
  Eighty patients underwent surgery for CP during the study period. Of these, 15 patients received biliary derivation with the FP. Eight of the FPs (53.3%) were combined with choledochoduodenostomy, 4 (26.7%) with choledochojejunostomy and 3 (20.0%) with reinsertion of the CBD into the resection cavity. The mean operating time was 390 minutes. Eleven complications (73.3%) were recorded, including one major complication (6.7%) that necessitated radiologically-guided drainage of an abdominal collection. The mean (range) length of stay was 17 days (8-28) and the median (range) follow-up time was 35.2 months (7.2-95.4). Two patients presented stricture after CBD reinsertion into the resection cavity; one was treated with radiologically-guided dilatation and the other underwent revisional Roux-en-Y choledochojejunostomy. Three patients presented alkaline reflux gastritis (37.5%), one (12.5%) cholangitis and one CBD stricture after FP with choledochoduodenostomy. No risk factors for secondary CBD stricture were identified.
  
  
  CONCLUSIONS
  As part of a biliary derivation, the FP gave good results. We did not observe any complications specifically related to surgical treatment of the biliary tract. However, CBD reinsertion into the resection cavity appeared to be associated with a higher stricture recurrence rate. In our experience, choledochojejunostomy remains the "gold standard" for the surgical treatment for CBD strictures.
authors: Department of Digestive Surgery, Amiens University Medical Center and the Jules Verne University of Picardie, Amiens, France. regimbeau.jean-marc@chu-amiens.fr.
authors: Lionel
authors: L
authors: Rebibo
authors: Thierry
authors: T
authors: Yzet
authors: Cyril
authors: C
authors: Cosse
authors: Richard
authors: R
authors: Delcenserie
authors: Eric
authors: E
authors: Bartoli
authors: Jean-Marc
authors: JM
authors: Regimbeau
mesh_terms: D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D002768:Choledochostomy / Q000379:methods*; D003137:Common Bile Duct Diseases / Q000150:complications*; D003251:Constriction, Pathologic / Q000150:complications; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D050500:Pancreatitis, Chronic / Q000209:etiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D011446:Prospective Studies; D012008:Recurrence; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome