title: Influence of bile duct obstruction on the results of Frey's procedure for chronic pancreatitis.
abstract: OBJECTIVE
  To evaluate the influence of a biliary obstruction (BO) requiring biliary bypass on both short and long-term outcomes of patients undergoing Frey's procedure for chronic pancreatitis (CP).
  
  
  METHODS
  From 1999 to 2010, 33 consecutive patients underwent Frey's procedure for CP in two centers. Seventeen (54%) patients underwent biliary bypass to treat an associated BO. Characteristics and outcomes of these patients were compared to those of 16 others without BO.
  
  
  RESULTS
  Patients with BO had more severe disease including lower BMI and larger pancreatic head (4 cm vs. 6 cm, p = 0.021). The operative mortality was nil. Patients with BO experienced more overall postoperative complications (71% vs. 31%, p = 0.024) but similar major complication rates (18% vs. 6%, p = 0.316) compared to those without BO. After a median follow-up of 51 (1-96) months, 91% of the patients experienced either partial or complete relief of their symptoms and 36% exhibited deterioration of their endocrine function. Multivariate analysis revealed preoperative BO to be associated with long-term impairment of endocrine function (OR: 43.249; 95% CI 2.221-84.277; p = 0.013).
  
  
  CONCLUSIONS
  In patients undergoing Frey's procedure for CP, associated BO can be safely managed using biliary bypass. However, the severity of CP in these patients is responsible for a higher risk of long-term endocrine insufficiency.
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France.
authors.forename: F
authors.initials: F
authors.lastname: Cauchy
authors.affiliation: Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France.
authors.forename: J M
authors.initials: JM
authors.lastname: Regimbeau
authors.affiliation: Department of Digestive Surgery, CHU Amiens-Picardie, Place Victor Pauchet, 80054 Amiens Cedex, France.
authors.forename: D
authors.initials: D
authors.lastname: Fuks
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France.
authors.forename: P
authors.initials: P
authors.lastname: Balladur
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France.
authors.forename: E
authors.initials: E
authors.lastname: Tiret
authors.affiliation: Department of Digestive Surgery, Hôpital Saint Antoine, 184, rue du faubourg Saint Antoine, 75570 Paris Cedex 12, France. Electronic address: francois.paye@sat.aphp.fr.
authors.forename: F
authors.initials: F
authors.lastname: Paye
mesh_terms: D000328:Adult; D000368:Aged; D002779:Cholestasis / Q000150:complications / Q000601:surgery; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010193:Pancreaticojejunostomy / Q000379:methods; D050500:Pancreatitis, Chronic / Q000601:surgery*; D011183:Postoperative Complications / Q000209:etiology; D016896:Treatment Outcome
keywords: Biliary obstruction; Chronic pancreatitis; Diabetes; Frey's procedure; Pain