|
Back to 2014 Annual Meeting Abstracts
Re-Interventions After Frey Procedure for Chronic Pancreatitis: Does Radicality of Head Coring Influence Outcomes?
Hariharan Ramesh*, Mahesh Subramaniaiyer, Ambady Venugopal, V. Lekha
Lakeshore Hospital & Research Center, Cochin, India
Background: There is insufficient knowledge regarding the extent of head coring in patients with chronic pancreatitis.
Aim: Analyze outcomes of Frey procedure for chronic pancreatitis in three time periods.
Materials and Methods: Five hundred patients underwent Frey procedure during a 27 year period. They were subdivided into 3 groups (A, B and C). The characteristics are in table 1.
Results: 70 reinterventions were needed in 53 patients (10.6%). 45 were endoscopic and 25 surgical. The details are provided in table 2. Reinterventions occurred in 34/105 patients in group A (32%), 27/192 patients in group B (14%) and 7/203 patients in group C (3%). Pain relief rates is group A, B and C were 84, 88 and 94%.
Conclusion: Increasing extent of head coring is associated with fewer reinterventions and improved pain relief. The critical aspects of head coring are: 1. complete stone clearance in the head as guided by intraoperative C arm xray; 2. Only posterior capsule was left behind 3. procedure extent not influenced by size of the inflammatory mass formation, even performed when there was no mass; 4. Probe must enter the ampulla into the duodenum from the cored out pancreas; 5. inferior aspect of the head below the main pancreatic duct cored out as well. Table 1: characteristics of groups | Parameter | Group A | Group B | Group C | | Time period | 1993-1997 | 1998-2004 | 2005-2010 | | Number of patients | 105 | 192 | 203 | | Characteristics | | | | | Triangular wedge of head removed | yes | yes | complete head coring | | Head duct cleared upto papilla | no | yes | yes | | Sentinel stone removed | no | yes | yes | | inferior part of head below main duct cored | no | yes | yes | | frey only when mass was present | yes | yes | no, always |
Table 2: reinterventions | Pathology | type of intervention | Group A n=105 | Group B n=192 | Group C n=203 | | Biliary obstruction | ERCP/stent | 12 | 10 | 5 | | Inflammatory head mass | ERCP/pancreatic stent | 3 | 2 | 1 | | pseudocyst head | ERCP/transpapillary drainage | 6 | 3 | 0 | | Pseudocyst head | Endoscopic drainage | 2 | 1 | 0 | | Biliary obstruction | Choledochoduodenostomy | 1 | 2 | 0 | | inflammatory head mass | Pancreaticoduodenectomy with lateral drainage | 3 | 3 | 0 | | inflammatory head mass | side-to-side drainage of jejunal Roux loop | 0 | 1 | 0 | | Intestinal obstruction | release of adhesions | 2 | 1 | 1 | | Internal herniation | Reduction with closure of defect | 1 | 0 | 0 | | abscess pancreatic tail | drainage | 1 | 1 | 0 | | inflammatory head mass | re-head coring | 5 | 3 | 0 |
Back to 2014 Annual Meeting Abstracts
|
