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frey's procedure

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background

Resection of the pancreas requires control of tributaries of the superior mesenteric vein (SMV) inferior to the head of the pancreas as well as separation of the posterior surface of the pancreas from the SMV and from eventually existing collateral veins. This usually is the most tedious part when performing a resection of the pancreatic head, in particular if there are signs of portal hypertension. Portal vein pathology contributes to intra- and postoperative morbidity in pancreatic surgery.

surgery

 The surgical strategy is largely governed by morphological changes to parenchymal and pancreatic ductal tissue. As much as possible of the normal upper gastrointestinal anatomy and pancreatic parenchyma should be preserved to avoid problems with diabetes mellitus and malabsorption of fat. The currently favoured operations are duodenal preserving resection of the pancreatic head (Beger procedure) and extended lateral pancreaticojejunostomy (Frey's procedure). More extensive resections such as Whipple's pancreatoduodenectomy and total pancreatectomy are occasionally required. The results of surgery are variable; most series report a beneficial outcome in 60-70% of cases at five years, but the benefits are often not sustainable in the long term. It is often difficult to determine whether failures are surgically related or due to narcotic addiction.

Peustow Procedure

In this operation no tissue is removed but the dilated main pancreatic duct is drained into the small bowel by a Roux-en-Y procedure. This operation is used if the pancreas is not badly affected apart from obstruction to the pancreatic duct.

Frey's Procedure

This is almost identical to the Peustow operation but some tissue is removed from the head of the pancreas although less than in Beger's operation. A Roux-en-Y enterostomy is used to drain the cut parts of the pancreas.


 

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before frey's

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during frey's

frey_after_lrg.jpg
after frey's

 

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