Comprehensive Outcomes of the Frey Procedure: A Single-center Perspective

Chronic pancreatitis is a severe, ongoing inflammation of the pancreas, characterized by significant abdominal pain and deficiencies in both exocrine and endocrine functions. This condition greatly reduces overall well-being, induces psychological distress, and results in a considerable economic burden. The primary indication for surgical intervention is uncontrollable pain. Frey's procedure is the preferred surgical option.

This research aims to assess the effectiveness of long-term pain management in individuals with chronic pancreatitis who have undergone the Frey procedure, using a validated pain assessment tool. Additionally, it evaluates exocrine and endocrine insufficiencies along with overall quality of life.

This is a retrospectively analyzed prospective study conducted at KIMS-Sunshine Hospital, Secunderabad. We evaluated 48 patients who underwent the Frey procedure from 2016 to 2021, each with a follow-up period of at least 1 year. The assessment comprised the validated Izbicki pain score along with evaluations of exocrine and endocrine functions, quality of life using the SF-6 questionnaire, and nutritional status, considering factors such as steatorrhea, glycemic control, and weight gain.

The total number of patients enrolled was 52. Four patients were identified intraoperatively as having malignancy by frozen section and were therefore converted to the Whipple procedure. Therefore, 48 patients (30 = male, 18 = female, mean age 35.2 years) were analyzed in this study. About 6 patients underwent hepaticojejunostomy along with Frey's procedure in view of benign biliary stricture.In this study of 48 patients, the preoperative mean overall pain score was 66.67. Postoperative mean overall pain scores were recorded at 3, 12, 36, and 60 months, showing values of 6.27, 6.37, 8.26, and 8.42, respectively. These results indicate a clear and statistically significant (p < 0.05) reduction in pain both in the immediate and extended follow-up periods.In the first 3 months following surgery, there was weight gain in most of the patients (65%). Though some patients showed mild weight loss subsequently on long-term follow-up, it was not statistically significant (p-value = 0.041).The SF-36 quality of life questionnaire indicated a general improvement in quality of life for the entire group, largely attributable to a reduction in pain. Preoperatively, the mean physical component score (PCS) and mental component score (MCS) were 25.37 ± 6.67 and 26.28 ± 9.94, respectively. These scores increased to 57.78 ± 15.56 and 48.30 ± 26.82 at 3 years, with a p-value of < 0.05.

Frey's procedure is safe and effective in relieving pain in chronic calcific pancreatitis (CCP) with improved quality of life and seems to be better than PD stenting. However, it has no role in the control of exocrine and endocrine pancreatic insufficiency.

Eppa VR, Musham R, Senapathy G. Comprehensive Outcomes of the Frey Procedure: A Single-center Perspective. Euroasian J Hepato-Gastroenterol 2024;14(2):182-186.