Dérivation pancréaticojéjunale dans le traitement des pancréatites chroniques

[Management of chronic pancreatitis: endoscopy or surgery?]

The indications for interventional treatment (endoscopic or surgical) of chronic pancreatitis can be classified in several major groups of lesions or symptoms: pain, consequences of fibrosis on neighboring organs (biliary, duodenal or even colic stenosis, thrombosis of the splenic vein with segmental portal hypertension), consequences of duct rupture above the obstacle (persistent symptomatic pseudocyst, refractory pancreatic ascites), and suspected cancer. Finally, surgery is indicated for patients for whom endoscopic procedures are impossible (papillae inaccessible) or too close together. Recently, two new criteria have been suggested: the number of procedures necessary for achieving the objective set, and the duration of hospitalization.

Frey procedure in the treatment of chronic pancreatitis: short-term results

OBJECTIVE

The aim of this multicenter study was to report the short-term results of the Frey procedure in the treatment of chronic pancreatitis.

METHODS

For the period between September 2000 and January 2005, 34 Frey procedures were performed for chronic pancreatitis in 4 university hospitals. This study includes 31 men (91%) and 3 women (9%), with a mean age of 48 +/- 6 years (range, 32-58 years). The etiology of chronic pancreatitis was chronic alcohol ingestion in 32 patients (94%) and hereditary chronic pancreatitis in 2 patients. The indications of surgery were abdominal pain in all patients, requiring opiates in 59% (n = 20) and associated with a weight loss in 79% (n = 27).

RESULTS

There was no mortality. Eleven postoperative surgical complications occurred in 7 patients (20%). Three patients had a single complication, and 4 patients had 2 complications. Pancreatic fistula occurred in 4 patients and healed under conservative management in all cases. One patient had massive bleeding from the stump of gastroduodenal artery requiring reoperation. The mean hospital stay was 16 +/- 8 days (range, 9-40 days). The mean follow-up was 15 +/- 12 months (range, 3-37 months). At the time of the last follow-up visit, the examiner judged that 19 patients (56%) have complete pain relief and 11 patients (32%) have substantial pain relief. No patient used narcotic analgesics postoperatively. Seven patients developed diabetes mellitus, requiring insulin (n = 1), oral hypoglycemic agents (n = 5), and diet adjustment (n = 1). Four patients developed exocrine insufficiency. Weight increases with a mean of 4.8 +/- 5.4 kg (range, 1-24 kg) in 27 patients (79%).

CONCLUSIONS

Frey procedure appears as a safe technique with low mortality and morbidity rates and allows effective pain relief in about 90% of patients.