Reoperation for Relapsing Pancreatitis after Frey Procedure for Chronic Pancreatitis

Shinichi Egawa, Yoh Kitamura, Naoaki Sakata, Shigeru Ottomo, Hisashi Abe, Masanori Akada, Fuyuhiko Motoi, Toshiki Rikiyama, Yu Katayose and Michiaki Unno

Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine

Background and Aims: The Frey procedure involves longitudinal pancreaticojejunostomy with coring of the pancreatic head for chronic pancreatitis. During follow-up, we encountered peripancreatic abscess that required reoperation. We analyzed the long-term outcome in terms of reoperation for patients with chronic pancreatitis undergoing Frey procedure. Patients and Methods: Of 62 patients undergoing the Frey procedure from 1992 to 2008, eight patients required reoperation during follow-up period (Median 45.5 months). Results: Early postoperative morbidity was 15.2% (10 cases) with median postoperative hospital stay of 19.5 days. In long-term follow-up, one patient required choledochoduodenostomy with repititive cholangitis. One required pancreatoduodenectomy for suspicious cancer. Four required distal pancreatectomy and one required cystojejunostomy for the most common type of left-sided relapse. All of them could not stop drinking after the first operation, except for one patient with idiopathic chronic pancreatitis. The mean duration before reoperation was 2 years after the Frey procedure. Resection of the pancreatic tail and recapping using the jejunal loop end effected satisfactory troubleshooting procedure for peripancreatic abscess of the pancreatic tail after the Frey procedure. Conclusion: Abstaining from drinking and sufficient drainage is critically important to preventing the relapse of inflammation. Once relapsed, reoperation should be conducted precisely and positively.

Key words
Frey procedure, chronic pancreatitis, reoperation, alcoholism, recapping

Reprint requests
Shinichi Egawa Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tohoku University Graduate School of Medicine
1-1 Seiryo Aoba, Sendai, 980-8574 JAPAN

Accepted
October 22, 2008

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