Frey’s procedure - does it improve quality of life? A single centre experience of long term outcome following Frey’s procedure

Background: The objective of the study was to find out long term outcome of patients who underwent Frey’s procedure for chronic calcific pancreatitis.Methods: This is a prospective observational study from retrospectively collected data of all patients who underwent Frey’s procedure for chronic calcific pancreatitis in Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai from January 2012 to December 2014. All patients who have completed at least 48 months after surgery were followed up and their long-term postoperative quality of life were analyzed.Results: Totally 48 patients underwent Frey’s procedure during this period. Eight patients lost follow up. Preoperatively all patients had pain score above six in numerical rating scale but after surgery only two patients in the long term required stronger opioids for pain relief. Exocrine deficiency was present in 24 (60%) patients preoperatively, out of which seven patients showed improvement, eight patients had worsened exocrine deficiency and weight loss. Post operatively there were six patients who developed exocrine deficiency. Endocrine deficiency was seen in 23 (57.5%) patients preoperatively and during follow up none showed improvement, with two (5%) patients developed endocrine deficiency. Seven patients showed worsened endocrine deficiency as documented by increasing insulin requirement. Quality of life analysis using SF 36 showed poor quality of life in patients with worsened exocrine deficiency.Conclusions: Frey’s procedure although in long term showed improved outcome in terms of pain free survival and overall quality of life, exocrine and endocrine deficiency persisted in most and worsened in some patients.

Extracorporeal shock wave lithotripsy and endotherapy for pancreatic calculi—a large single center experience.

Aim Large pancreatic ductal calculi and pain are a feature of chronic calcific pancreatitis (CCP) in the tropics. This large single center study evaluates the role of extracorporeal shock wave lithotripsy (ESWL) in fragmentation of large pancreatic stones and relief of pain in patients with CCP. Methods Patients with CCP presenting with pain and large pancreatic duct (PD) calculi (>5 mm diameter) not amenable to extraction at routine endoscopic retrograde cholangio pancreatography (ERCP) were taken up for ESWL using a 3rd generation lithotripter. Stones in the head and body of pancreas were targeted at ESWL; 5,000 shocks were given per session. The calculi were fragmented to <3 mm size and then cleared by endotherapy. Pancreatic duct stents were deployed when indicated. A total of 1,006 patients underwent ESWL. Complete clearance was achieved in 762 (76%), partial clearance in 173 (17%) and unsuccessful in the rest. More than 962 (90%) of patients needed less than three sessions of ESWL. At 6 months, 711 (84%) of 846 patients who returned for follow up had significant relief of pain with a decrease in analgesic use. Complications were mild and minimal. Conclusion ESWL is an effective and safe modality for fragmentation of large PD calculi in patients with CCP.