PROSPECTIVE RANDOMIZATION STUDY TO COMPARE CLINICAL OUTCOME AND PANCREATIC PERFUSION FOLLOWING FREY'S PROCEDURE VERSUS MODIFIED FREY'S PROCEDURE (HEAD PLUS BODY CORING) IN CHRONIC PANCREATITIS.
Amaresh Aruni*1, Vikash Moond1, Aditya Kulkarni1, Mandeep Kang2, Surinder S. Rana4, Harjeet Singh3, Ujjawal Gorsi2, Rajesh Gupta3
1General Surgery, PGIMER, Chandigarh, India; 2RADIODIAGNOSIS, PGIMER, CHANDIGARH, CHANDIGARH, India; 3SURGICAL GASTROENTEROLOGY, PGIMER, CHANDIGARH, CHANDIGARH, India; 4GASTROENTEROLOGY, PGIMER, CHANDIGARH, CHANDIGARH, India
AIM: To compare the clinical outcome & pancreatic perfusion following head coring (Frey's procedure) versus head plus body coring (Modified Frey's procedure, MF) in chronic pancreatitis.
METHODS: This was a single center prospective study done from Jan 2015 to December 2017. All patients of chronic pancreatitis with intractable pain, gastric outlet obstruction, biliary obstruction, pseudocyst & suspicion of malignancy were included in the study and underwent: FBS, PPBS, HbA1c, C- peptide, fecal elastase, EUS & CECT abdomen. CT pancreatic perfusion was performed in 14 patients (7 in each group) in pre-operative & at 3 months post-operatively (Parameters studied included: blood flow, blood volume & permeability at head, body & tail regions of the pancreas). Total of 34 patients were randomised for Frey's versus Modified Frey's surgery (17 patients for MF group, 16 for Frey's & 1 underwent pancreatoduodenectomy) & all patients were followed at 1, 3 & 6 months after surgery.
RESULTS: All operated patients had significant relieve of pain, but without significant difference of pain between the 2 groups using Izbicki & visual analogue pain score. Among 10 diabetic patients in Frey's group 8 had improvement, 1 had resolution of diabetes while 1 died. Among 6 diabetics in MF group 3 showed improvement, 1 patient had no change,1 showed worsening initially for 3 months, later controlled with oral hypoglycaemic agents, 1 developed new onset DM treated with insulin initially & had complete resolution at 1 year follow up, while 1 patient died. No exocrine insufficiency noted in either groups. CT pancreatic perfusion increased after surgery but no significant difference noted between 2 groups. Significant improvement in quality of life noted in both groups assessed by EORTC QLQ-30 at 3 & 6 months.
Duration of surgery was more in Frey's group (mean 4.1 hrs ±1.15 hrs) than MF group (mean of 3.6 hrs ±0.71 hrs). Mean blood loss was more in MF group [Frey's = 243±149.2 ml, MF = 271±225.95ml]. Complications like pancreatico-jejunostomy leak (Frey's = 1 patient, MF = 2 patients), intra-abdominal collection (Frey's = 1 patient, MF = 2 patients) were noted & managed non-operatively. Management for post-operative bleeding ( 6 patients= 2 in Frey's & 4 in MF) done by embolisation (1 patient) & surgery ( 5 patients). Mean post-operative stay in Frey's group [8.9±5.02 days] was less than MF group [10.72±0.69 days]. All patients are currently free of any analgesia use. 3 patients succumbed to death (1 in Frey's group & 2 in MF group) at 6 months after follow up.
CONCLUSION: All patients had significant relief of pain, improved quality of life, improvement in glycemic control & pancreatic perfusion was noted in both groups however no significant difference noted in two groups. No new onset of exocrine insufficiency noted after in either groups.
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