Technical features of Frey's operation in patients with complicated forms of chronic pancreatitis
DOI:
https://doi.org/10.32782/2415-8127.2023.68.19Keywords:
chronic pancreatitis, Frey's procedure, technical featuresAbstract
Introduction. In recent years, in chronic pancreatitis (CP), resection surgery with preservation of the pancreas is used as an alternative to draining operations and pancreatoduodenectomy. Thanks to the evolution of surgical techniques, the Frey operation, which uses a hybrid nature, has become a popular surgical intervention with a significant reduction in pain and a low rate of intraoperative complications. The aim. Evaluation, substantiation of technical techniques and explanation of the stages of Frey's operation depending on the severity of pancreatic pathology (PA) in patients with a complicated course of CP. Research material and methods. During the period from 2014 to 2021, Frey's operation was performed on 78 patients. Among the examined patients, there were 70 (89.7%) men and 8 (10.3%) women. The average age of the patients is (47.58±5.09) years. The average duration of the p/o period was (14.1±6.3) days. The duration of operations ranged from 174.5 to 256.4 minutes. Research results and their discussion. The most difficult and critical task of Frey's operation is decompression and resection of the head of the PZ with mandatory excision of the main, accessory, and hook-like process ducts. In the postoperative period, complications according to Clavien-Dindo developed in 5 (6.4%) patients. 2 (2.6%) had postoperative wound complications (class I). In 3 (3.8%) patients, clinically significant complications developed: 1 bleeding in the area of excision of the head, 1 failure of the anastomosis sutures, which caused repeated surgical interventions under general anesthesia (class 3b), 1 postoperative pancreatic fistula (PPF), which closed due to conservative measures (class II), grade B. In the group of clinically significant complications, 1 patient died. Postoperative mortality is 1.3%. Conclusions The use of a more radical excision of the head in comparison with a local excision gives the right to believe that the modern Frey operation has transformed into a subtotal duodenum-preserving resection of the head with provision, according to the indications, of a more radical excision of the tributaries along the course of the GPP in the area of the body and tail of the pancreas.
References
Gloor B., Friess H., Uhl W., Buchler M.W. A Modified Technique of the Beger and Frey Procedure in Patients with Chronic Pancreatitis. Dig Surg 2001; 18: 21–25. https://doi.org/10.1159/000050092
Frey C.F., Mayer K.L. Comparison of Local Resection of the Head of the Pancreas Combined with Longitudinal Pancreaticojejunostomy (Frey Procedure) and Duodenum-Preserving Resection of the Pancreatic Head (Beger Procedure). World J Surg 2003; 27: 1217–1230.
Köninger J, Seiler C.M., Sauerland S et al Duodenum-preserving pancreatic head resection – a randomized controlled trial comparing the original Beger procedure with the Berne modification. Surgery 2008;143(4):490–498
Ni Q, Yun L, Roy M, et al. Advances in surgical treatment of chronic pancreatitis. World J Surg Oncol 2015;13:34.
Усенко О.Ю., Копчак В.М., Ничитайло М.Ю., Дувалко О.В. та інш. Сучасні принципи хірургічного лікування хронічного панкреатиту. Журнал Національної академії медичних наук України. 2019;25(3):306–12
Roch A. Chronic pancreatitis: a surgical disease? Role of the Frey procedure. World J Gastrointest Surg. 2014;6(7):129. doi: 10.4240/wjgs.v6.i7.129.
Tillou J.D., Tatum J.A., Jolissaint J.S., Strand D.S,. Wang A.Y., Zaydfudim V., Adams R.B., Brayman K.L. Operative management of chronic pancreatitis: a review. Am J Surg. 2017;214(2 9):347–357. doi: 10.1016/j.amjsurg.2017.03.004.
Ingrid Kvåle Nordaas, Erling Tjora, Georg Dimcevski et.al. Structural imaging findings are related to clinical complications in chronic pancreatitis United European Gastroenterol J. 2022; 10:385–395 DOI: 10.1002/ueg2.12228
В.М. Ратчик, Т.Г. Турицька, Г.В. Олійников Неінвазивна та інвазивна діагностика фіброзу підшлункової залози у хворих з ускладненими формами хронічного панкреатиту Український журнал медицини, біології та спорту. – 2021; 6, 4 (32): 111–118 DOI: 10.26693/jmbs06.04.111
Yang C.J., Bliss L.A., Schapira E.F., et al. Systematic review of early surgery for chronic pancreatitis: impact on pain, pancreatic function, and re-intervention. J Gastrointest Surg 2014;18:1863–9.
Zhou Y., Shi B., Wu. L., et al. Frey procedure for chronic pancreatitis: evidence-based assessment of short- and long-term results in comparison to pancreatoduodenectomy and Beger procedure: a meta-analysis. Pancreatology 2015;15:372–9.
Dindo D., Demartines N., Clavien P. A. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey // Ann. Surg. 2004; 240( 2): 205–213. – PubMed PMID: 15273542.
Bassi C., Dervenis C., Butturini G., et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery 2005;138:8–13.
Frey C.F., Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Ann. Surg. 1994;220:492–504.
Negi S., Singh A., Chaudhary A. Pain relief after Frey's procedure for chronic pancreatitis. Br. J. Surg. 2010;97:1087–1095.
Gestic M.A., Callejas-Neto F., Chaim E.A., et al. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience. HPB (Oxford) 2011;13:263–271.
Ray S., Das K., Khamrui S., et al. Short- and long-term outcome of Frey procedure for chronic pancreatitis in adults. Am. J. Surg. 2021;11 S0002-961000078-7.
V. Kochatcov, A.G. Kriger, S.V. Berelavichus, S.V. Korolev et.al The resection of the head of the pancreas with longitudinal pancreatojejunostomy (Frey procedure) Khirurgiia 2012; 2: 31–35.
