Background: Partial pancreatic head resection with lateral pancreaticojejunostomy (Frey procedure) is a well-described successful treatment for symptomatic patients with chronic pancreatitis. To our knowledge, completion of this procedure laparoscopically has not previously been reported. While laparoscopic lateral pancreaticojejunostomy alone has been reported, the Frey procedure has several advantages and is increasingly performed (via laparotomy) over other drainage procedures. Our aim is to describe the technical aspects and feasibility of the laparoscopic Frey procedure.
Methods: Retrospective review of patient records, operative and perioperative data.
Results: Two female patients (age 57 and 72 years) underwent a laparoscopic Frey procedure at our institution during the year of 2007. Clinical and radiographic evaluation confirmed chronic calcific pancreatitis with medically refractory abdominal pain. Both patients had parenchymal calcification, ductal stones, and a diffusely dilated pancreatic duct on CT imaging. The operative procedure was completed laparoscopically in both patients. Steps of the procedure included: 1) Exposure of the lesser sac through the gastrocolic ligament; 2) Laparoscopic ultrasound to assess the pancreatic ductal anatomy and surrounding vasculature; 3) Opening of the pancreatic duct in the body with extension to the termination of the duct in the tail; 4) Placement of hemostasis sutures and the duodenopancreatic interface; 5) V-shaped wedge resection of pancreatic parenchyma anterior to the duct in the neck, widening to a core resection of parenchyma from the pancreatic head; 6) Stone retrieval from the pancreatic duct and exposed branch ducts; 7) Roux-en-Y pancreaticojejunostomy with a single layer of running suture. The mean operative time and estimated blood loss were 246 minutes (155-337) and 138 ml (100-175) respectively. In both patients, histologic confirmation of chronic pancreatitis in the resected pancreatic specimen was obtained, with a mean specimen weight of 660 milligrams (650-664). Mean length of hospital stay was 6.5 days (5-8). Both patients reported near resolution of preoperative pain symptoms at time of discharge. No perioperative morbidity or mortality was observed.
Conclusion: This is the first report describing completion of the laparoscopic Frey procedure and demonstrates the technical feasibility of this approach. Appropriate assessment of outcomes will require additional patients and longer follow-up to substantiate expected benefits and equivalent long-term results of the laparoscopic versus conventional laparotomy approach.