Aim: To assess the feasibility of the Frey procedure in relieving biliary obstruction without a separate drainage procedure.Patients: The data of 79 patients with chronic pancreatitis and biliary obstruction (bile duct diameter>7 mm with abnormal liver function tests) who were treated surgically over an 8 year period was analyzed. Patients with cancer were excluded. 59 patients who underwent Frey procedure were included.Procedure: Initial cystic duct cholangiography was followed by adequate head coring, after which cholangiography was repeated. Further management was dependent on:a) Free flow of contrast into duodenum: no additional procedure: n=21b) Extensive structuring of and confined to intrapancreatic common bile duct: longitudinal bile ductotomy and incorporation into the Roux-en-Y pancreaticojejunostomy (internal biliary drainage): n=28c) Free flow of contrast, but deep jaundice, and/or cholangitis: additional short term (6 weeks) T tube drainage: n=5d) Stricture extending beyond intrapancreatic common bile duct:a. Healthy duodenum and CBD diameter ≥1.5 cm: side-to-side choledochoduodenostomy; n=4b. Unhealthy, edematous duodenum with thick walled CBD: hepaticojejunostomy onto same loop of jejunum as pancreatic anatomosis: n=1Results: follow up 36-124 months (see table)Conclusion: Frey procedure relieved biliary obstruction without an additional biliary drainage procedure. When stricturing was unrelieved by head coring, internal drainage of the bile duct into the pancreaticojejunostomy could be achieved without deleterious effects.
Patient data and results

Group	Bilirubin (mean)(mgs%)	cholangitis	Biliary obstruction relief after surgery	Postoperative interventions
A	3.6	4	19/21	2: temporary endoscopic stenting
B	4.2	7	24/28	2: temporary endoscopic stenting, 2: choldochoduodenostomy
C	9.8	3	5/5	5: endoscopi stenting
D	7.2	1	5/5

Selective biliary cannulation during ERCP opacifying pancreaticojejunostomy.