Retrospective Study
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Nov 28, 2015; 21(44): 12644-12652
Published online Nov 28, 2015. doi: 10.3748/wjg.v21.i44.12644
Single center experience in selecting the laparoscopic Frey procedure for chronic pancreatitis
Chun-Lu Tan, Hao Zhang, Ke-Zhou Li
Chun-Lu Tan, Hao Zhang, Ke-Zhou Li, Department of Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu 610041, Sichuan Province, China
Author contributions: Li KZ designed the research; Tan CL and Zhang H collected data and wrote the paper.
Conflict-of-interest statement: The authors have no conflicts of interest or financial ties to disclose.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Ke-Zhou Li, PhD, Department of Pancreatic Surgery, West China Hospital, Sichuan University, No. 37 Guo Xue Xiang, Chengdu 610041, Sichuan Province, China. huaxipancreas@163.com
Telephone: +86-28-85422474 Fax: +86-28-85422474
Received: February 2, 2015
Peer-review started: February 5, 2015
First decision: April 24, 2015
Revised: May 14, 2015
Accepted: August 28, 2015
Article in press: August 31, 2015
Published online: November 28, 2015
Abstract

AIM: To share our experience regarding the laparoscopic Frey procedure for chronic pancreatitis (CP) and patient selection.

METHODS: All consecutive patients undergoing duodenum-preserving pancreatic head resection from July 2013 to July 2014 were reviewed and those undergoing the Frey procedure for CP were included in this study. Data on age, gender, body mass index (BMI), American Society of Anesthesiologists score, imaging findings, inflammatory index (white blood cells, interleukin (IL)-6, and C-reaction protein), visual analogue score score during hospitalization and outpatient visit, history of CP, operative time, estimated blood loss, and postoperative data (postoperative mortality and morbidity, postoperative length of hospital stay) were obtained for patients undergoing laparoscopic surgery. The open surgery cases in this study were analyzed for risk factors related to extensive bleeding, which was the major reason for conversion during the laparoscopic procedure. Age, gender, etiology, imaging findings, amylase level, complications due to pancreatitis, functional insufficiency, and history of CP were assessed in these patients.

RESULTS: Nine laparoscopic and 37 open Frey procedures were analyzed. Of the 46 patients, 39 were male (85%) and seven were female (16%). The etiology of CP was alcohol in 32 patients (70%) and idiopathic in 14 patients (30%). Stones were found in 38 patients (83%). An inflammatory mass was found in five patients (11%). The time from diagnosis of CP to the Frey procedure was 39 ± 19 (9-85) mo. The BMI of patients in the laparoscopic group was 20.4 ± 1.7 (17.8-22.4) kg/m2 and was 20.6 ± 2.9 (15.4-27.7) kg/m2 in the open group. All patients required analgesic medication for abdominal pain. Frequent acute pancreatitis or severe abdominal pain due to acute exacerbation occurred in 20 patients (43%). Pre-operative complications due to pancreatitis were observed in 18 patients (39%). Pancreatic functional insufficiency was observed in 14 patients (30%). Two laparoscopic patients (2/9) were converted. In seven successful laparoscopic cases, the mean operative time was 323 ± 29 (290-370) min. Estimated intra-operative blood loss was 57 ± 14 (40-80) mL. One patient had a postoperative complication, and no mortality was observed. Postoperative hospital stay was 7 ± 2 (5-11) d. Multiple linear regression analysis of 37 open Frey procedures showed that an inflammatory mass (P < 0.001) and acute exacerbation (P < 0.001) were risk factors for intra-operative blood loss.

CONCLUSION: The laparoscopic Frey procedure for CP is feasible but only suitable in carefully selected patients.

Keywords: Chronic pancreatitis, Frey procedure, Laparoscopic surgery, Surgical outcome, Pain

Core tip: The Frey procedure is an effective treatment for the relief of pain in chronic pancreatitis. Although the open Frey procedure is well described, the laparoscopic Frey procedure is rarely reported in the literature. Here, we share our experience with nine of these cases and discuss reasons for procedural failure. In addition, we describe the criteria for candidate selection and the results from a data review of open Frey cases.