Frey procedure for chronic pancreatitis improves bile duct stricture

Chronic pancreatitis (CP), a progressive inflammatory disorder characterized by pancreatic fibrosis and degeneration, often leads to common bile duct (CBD) strictures. However, the optimal management of CBD strictures remains controversial.

We retrospectively analyzed 16 patients with CP and CBD strictures who underwent surgery at our institution between January 2007 and December 2024. Clinical characteristics, surgical outcomes, and impact of the Frey procedure on CBD stricture resolution were evaluated.

Among the 16 patients, 10 underwent biliary reconstruction and 6 underwent the Frey procedure alone. Postoperatively, CBD strictures improved in five of the six patients without biliary reconstruction (Frey alone), eliminating the need for a stent. Additionally, a long-term follow-up revealed that one patient who initially required a CBD stent experienced spontaneous improvement after the Frey procedure, suggesting its potential therapeutic effect on CBD strictures. A comparison between Frey procedure alone and biliary reconstruction cases revealed similar demographics; however, the Frey procedure alone significantly shortened operative time (p = 0.017).

The Frey procedure improved CBD strictures in the majority of patients with CP by alleviating pancreatic head inflammation and fibrosis. However, biliary reconstruction may be necessary in some cases. Further studies are required to establish the optimal treatment strategies.