LONG-TERM OUTCOMES FOLLOWING FREY'S PROCEDURE FOR CHRONIC PANCREATITIS – A TEN-YEARS OF SINGLE-CENTER EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTH INDIA

Background/Aim: Chronic pancreatitis (CP) is surgically treated in selected patient populations. Frey's procedure (FP) is the most commonly described procedure for CP with head mass. This study is being conducted to determine the long-term outcome and ef?cacy of FP in patients with CP in South India of various etiologies. Methods: This is a retrospective study of patients who underwent FP at our institution. Clinical features, perioperative ?ndings, and follow-up results were evaluated. A subgroup analysis of pain relief was performed between alcoholics and non-alcoholic groups and between patients receiving FP alone and FP with additional procedures. Of the 181 patients, alcohol was Results: the causative factor in 99 (54.69%), gallstones in 20 (11.04%), and idiopathic in 62 (34.25%). With a median follow-up of 43.49 months (range 12-72 months), 78 (43.09%) patients experienced complete pain relief. Due to persistent pain and the presence of preoperative diabetes mellitus (DM), pain relief in patients with postoperative complications was incomplete. New DM and exocrine dysfunction were reported in 25 years (13.81%) and 15 (8.28%) patients. Patients with a history of alcohol abuse, smoking, weight loss, and postoperative complications are associated with newly developed diabetes. FP is a Conclusion: safe surgical option for CP with acceptable perioperative complications and appropriate short-term and long-term pain management in properly selected patients. Continuous pain and preoperative DM were independent predictors of incomplete pain relief after FP. Symptoms associated with alcohol abuse, smoking, and weight loss were associated with the development of post-FP DM in the study population.

Alcoholic vs. non-alcoholic chronic pancreatitis: surgeons' perspective from a tertiary centre in india / Perspectiva dos cirurgiões sobre pancreatite crônica alcoólica vs. não-alcoólica de um centro terciário na índia

ABSTRACT Background: Although alcohol is the most common cause for chronic pancreatitis worldwide, idiopathic type is prevalent in India. Natural history and disease progression are different between these two groups. There is paucity of data comparing surgical outcome and quality of life in these patients. Aim: To evaluate clinical features, surgical outcome and quality of life between these two groups of patients. Method: All patients with chronic pancreatitis who underwent surgery were prospectively reviewed. Results: From 98 patients, 42 were alcoholic. Number of male and the mean age at the time of operation was significantly more in alcoholic patients. Smoking, preoperative hospital admission rate and the prevalence of local complications like inflammatory pancreatic head mass, biliary stricture and left sided portal hypertension were distinctly more common in alcoholic group. Frey procedure was required more commonly in alcoholic group. Mean postoperative hospital stay and overall postoperative complication rate were comparable between the two groups. Over a median follow up of 18 months there was significant improvement in quality of life and pain score in both the groups. Improvement of physical functioning score at follow-up was significantly more in alcoholic group but the requirement for analgesic medications were significantly more in alcoholic group. However, appetite loss was more perceived by non-alcoholic group. Conclusion: Alcoholic chronic pancreatitis presents with more local complications associated with chronic pancreatitis. Frey procedure is a safe and well accepted surgery in this group. Though they required more analgesic requirement in short term follow up, other aspects of quality of life are similar to non-alcoholic group.

RESUMO Racional: Embora o álcool seja a causa mais comum de pancreatite crônica em todo o mundo, a forma idiopática é prevalente na Índia. A história natural e a progressão da doença são diferentes entre esses dois grupos. Há escassez de dados comparando o resultado cirúrgico e a qualidade de vida entre eles. Objetivo: Avaliar as características clínicas, o resultado cirúrgico e a qualidade de vida entre esses dois grupos de pacientes. Método: Todos os pacientes com pancreatite crônica operados foram revisados ​​retrospectivamente. Resultados: Do total de 98 pacientes, 42 eram alcoolistas. O número de homens e a idade média no momento da operação foi significativamente maior nos alcoolistas. Tabagismo, taxa de internação pré-operatória e prevalência de complicações locais como massa inflamatória da cabeça do pâncreas, estenose biliar e hipertensão portal do lado esquerdo foram distintamente mais comuns no grupo de alcoolistas e o procedimento de Frey foi exigido mais comumente neste grupo. A média de internação pós-operatória e a taxa geral de complicações pós-operatórias foram comparáveis ​​entre os dois grupos. Ao longo de acompanhamento médio de 18 meses houve melhora significativa na qualidade de vida e pontuação de dor em ambos os grupos. A melhora no escore de funcionamento físico foi significativamente maior no grupo de alcoolistas, mas a necessidade de medicamentos analgésicos foi significativamente maior nos alcoolistas. No entanto, a perda de apetite foi mais percebida pelo grupo não alcoólico. Conclusão: A pancreatite crônica alcoólica se apresenta com mais complicações locais associadas à pancreatite crônica. O procedimento de Frey é operação segura e bem aceita neste grupo. Embora exigissem mais necessidade de analgésicos no acompanhamento em curto prazo, outros aspectos da qualidade de vida são semelhantes ao grupo não alcoólico.

Frey’s procedure: short term follow up results in terms of pain, endocrine and exocrine status, a tertiary care centre experience

Background: Chronic pancreatitis, a debilitating disease which affects the patient to an extent to render him bedridden sometimes and often make him/her unable to perform daily work, leading to poor quality of life, severe emotional stress and financial burden. Frey’s procedure one of the most commonly performed surgery in patient of chronic pancreatitis with stones in pancreatic duct and small inflammatory head mass. This procedure had shown promising results in terms of pain control with unclear outcome with respect to exocrine and endocrine status.Methods: Study was conducted in Government Kilpauk Medical College, Chennai during March 2016 to December 2019. Total 21 patients were followed up for 18 months and Post-operative pain was analysed using pain scoring system used by Bloechle et al. Exocrine status in terms of diarrhea, bloating sensation and Fecal Elastase level(preoperative and postoperative) were analysed. Patient glycaemic status were also analysed and compared. Patient Nutritional status was analysed in terms of weight gain.Results: In this study there was significant improvement in pain after surgery in terms of VAS pain Score (Preop Mean-82.14, Post-op Mean- 9.76, p<0.001) , frequency of pain (Preop Mean-78.57, Post-op Mean- 14.29, p<0.001), analgesia required (Preop Mean-15, Post-op Mean- 3.10, p<0.001), and inability to work due to pain (Preop Mean-80.95, Post-op Mean- 11.90, p<0.001). Overall total Pain score was significantly improved after surgery (Preop Mean-256.67, Post-op Mean- 39.05, p<0.001). There was significant weight gain and significant improvement in Fecal Elastase level in patients following surgery, however there was no significant difference in pancreatic exocrine status on the basis of symptoms.Conclusions: Frey’s procedure is very effective in pain control in properly selected patients of chronic calcific pancreatitis, and it also improves nutritional status of patient. Frey’s procedure might improve patient exocrine and endocrine status but further  multicentre studies are needed to come to a conclusion.