Related Experiment Videos
Inadvertent choledochotomy during Frey's procedure: management options.
Kenneth D'Cruz1, Natarajan Angamuthu, J Anand
1Unit of Surgical Gastroenterology and Laparoscopic Surgery, St John's Medical College Hospital, Bangalore 560 034.
Summary
Frey's procedure for chronic pancreatitis can lead to inadvertent intra-pancreatic common bile duct injury in some patients. Surgical techniques were adapted to manage these injuries during the procedure.
Area of Science:
- Gastroenterology
- Surgical Oncology
- Hepatobiliary Surgery
Background:
- Chronic pancreatitis often presents with inflammatory masses in the pancreatic head, necessitating surgical intervention.
- Frey's procedure is a common surgical approach for managing such complex cases.
- The intra-pancreatic common bile duct is anatomically close to the surgical field during Frey's procedure.
Observation:
- This study observed inadvertent injury to the intra-pancreatic common bile duct in 3 out of 9 patients undergoing Frey's procedure.
- The injuries occurred in the context of treating chronic pancreatitis with an inflammatory mass in the pancreatic head.
Findings:
- In one patient, the common bile duct injury was managed by extending choledochotomy and performing an anastomosis to the cored-out pancreatic parenchyma.
- In two other patients, hepatico-jejunostomy was performed using a Roux loop after lateral pancreatico-jejunostomy, addressing the bile duct injury.
Implications:
- These findings highlight a potential complication of Frey's procedure that requires careful surgical management.
- Modified surgical techniques can effectively address inadvertent bile duct injuries during Frey's procedure for chronic pancreatitis.
- Awareness of this complication is crucial for surgeons performing pancreaticoduodenectomy procedures.