Surgery for chronic pancreatitis--extended pancreaticojejunostomy.

BACKGROUND/AIMS: The role of Frey's operation as extended pancreatic duct drainage operation was evaluated in patients with chronic pancreatitis.

METHODOLOGY: 206 patients with chronic pancreatitis were surgically treated, evaluated and followed for a minimum period of 6 months, in order to ascertain the status of pancreatic function and pain relief for both pancreatic duct drainage operations, including Frey's operation, and pancreatectomy.

RESULTS: Pain relief was established in 62 out of 86 patients (72.1%) undergoing pancreas duct drainage operation, in 51 out of 65 patients (78.5%) undergoing pancreatectomy. Fourteen out of 16 patients undergoing standard pancreaticojejunostomy with either persistent or alleviated pain had impacted calculi or pseudocysts in the pancreatic head and uncinate process preoperatively. Seventeen patients (16.3%) maintained normal glucose tolerance. Improvement was noted in 15 patients (14.4%) and in 27 patients the condition worsened (26.0%). The 10 years survival ratio in patients with diabetes mellitus preoperatively was 67.5% significantly lower than in patients without diabetes mellitus, 81.3% (p = 0.0029). Frey's operation was performed in 11 patients, providing satisfactory pain relief and preserving pancreatic exocrine and endocrine function.

CONCLUSIONS: Frey's procedure should be considered as a new standard procedure in patients with pancreatic head complications and ductal dilatation in chronic pancreatitis.