Frey procedure combined with biliary diversion in chronic pancreatitis.
The Frey procedure has become the standard operative treatment in chronic painful pancreatitis. Biliary diversion could be combined when associated with common bile duct obstruction. The aim of the present study was to evaluate the impact of the type of biliary diversion combined with the Frey procedure on late morbidity.



The data from consecutive patients undergoing the Frey procedure and having a minimum follow-up of 2 years were extracted from a maintained prospective database. The mean endpoint was the rate of secondary biliary stricture after the Frey procedure combined with biliary diversion (bilioenteric anastomosis or common bile duct reinsertion in the resection cavity).



Between 2006 and 2013, 55 consecutive patients underwent the Frey procedure. Twenty-nine patients had common bile duct obstruction (52.7%). The technique of biliary diversion resulted in bilioenteric anastomosis in 19 patients (65.5%) and common bile duct reinsertion in 10 patients (34.5%). Preoperative characteristics and early surgical outcomes were comparable. Pain control was similar. There was significantly more secondary biliary stricture after common bile duct reinsertion than after bilioenteric anastomosis (60% vs 11%, P = .008).



Combined bilioenteric anastomosis during the Frey procedure is an efficient technique for treating common bile duct obstruction that complicates chronic painful pancreatitis. Bilioenteric anastomosis was associated with less secondary biliary stricture than common bile duct reinsertion in the pancreatic resection cavity.
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France; INSERM UM991, Foie métabolismes et cancer, Universite Rennes 1, Rennes, France.
Aude
A
Merdrignac
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France; INSERM UM991, Foie métabolismes et cancer, Universite Rennes 1, Rennes, France.
Damien
D
Bergeat
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France.
Michel
M
Rayar
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France; INSERM UM991, Foie métabolismes et cancer, Universite Rennes 1, Rennes, France.
Yann
Y
Harnoy
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France.
Kathleen
K
Turner
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France; INSERM UM991, Foie métabolismes et cancer, Universite Rennes 1, Rennes, France.
Laetitia
L
Courtin-Tanguy
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France.
Karim
K
Boudjema
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France.
Bernard
B
Meunier
CHU Rennes, Service de Chirurgie Hépatobiliaire et Digestive, Rennes, France; Université Rennes1, Faculté de médecine Rennes, Rennes, France; INSERM UM991, Foie métabolismes et cancer, Universite Rennes 1, Rennes, France. Electronic address: laurent.sulpice@chu-rennes.fr.
Laurent
L
Sulpice
D000328:Adult; D000368:Aged; D001662:Biliary Tract Surgical Procedures / Q000379:methods*; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003137:Common Bile Duct Diseases / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D005602:France; D006801:Humans; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D010147:Pain Measurement; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D050500:Pancreatitis, Chronic / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology / Q000503:physiopathology; D012008:Recurrence; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome