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Frey Procedure (Pancreatic Head Coring with Lateral Pancreaticojejunostomy)

Duodenum-preserving surgery for chronic pancreatitis with painful head enlargement.

Written by: Saygı Hospital Health Guide Editorial Board
Last updated:

This content has been compiled by the Saygı Hospital Health Guide Editorial Board and is periodically reviewed by a specialist physician.

This content is for informational purposes only and does not constitute medical advice. You can book an appointment at our Genel Cerrahi department. Book Appointment →

What is Frey Procedure (Pancreatic Head Coring with Lateral Pancreaticojejunostomy)?

The Frey procedure was described by Charles Frey in 1987 as a less invasive alternative to the Whipple operation for benign disease of the pancreatic head.

It removes the inflammatory mass of the pancreatic head while preserving the duodenum, the bile duct and most of the pancreatic parenchyma, decompressing the pancreatic duct along its entire length.

Compared with the Beger procedure, the Frey operation does not require complete transection of the pancreas at the neck, which simplifies the operation while achieving similar pain relief.

Symptoms

Indications: chronic pancreatitis with intractable pain refractory to medical and endoscopic therapy
Indications: pancreatic head enlargement (mass over 4 cm) with main duct dilatation
Indications: complications of pancreatic head disease such as common bile duct stricture, duodenal stenosis or portal vein compression
Symptoms relieved: chronic abdominal pain, postprandial pain, opiate dependence, weight loss
Contraindications: suspected pancreatic malignancy (pancreaticoduodenectomy preferred)
Contraindications: severe portal hypertension or unreconstructible vascular anatomy
Contraindications: small-duct disease without head enlargement (alternative procedures considered)

Risk Factors

Continued alcohol abuse drastically increases recurrence and overall mortality
Active smoking accelerates disease progression after surgery
Severe malnutrition before surgery increases postoperative complications
Diabetes mellitus may worsen after surgery despite parenchyma preservation
Genetic chronic pancreatitis (PRSS1, SPINK1, CFTR) has higher recurrence rates
Pancreatic fistula occurs in 5-15% of patients postoperatively
Long-term endocrine and exocrine insufficiency develops in many patients regardless of operation

When to See a Doctor?

If you experience any of the following symptoms, seek medical attention promptly:

  • Patients with chronic pancreatitis and pain unresponsive to non-opioid therapy and endoscopic treatments need surgical referral
  • Suspected pancreatic head mass requires CT, MRI/MRCP, endoscopic ultrasound and tumour markers to exclude malignancy
  • Bile duct or duodenal obstruction in chronic pancreatitis is an indication for surgery
  • Postoperative fever, jaundice, abdominal pain or vomiting suggests anastomotic leak or fistula and needs urgent evaluation
  • Long-term follow-up requires endocrine, exocrine and nutritional surveillance

Treatment Methods

01
Preoperative workup: contrast CT, MRI/MRCP, endoscopic ultrasound with biopsy if mass is suspicious, glycaemic and nutritional optimisation
02
Surgery performed via upper midline laparotomy under general anaesthesia (laparoscopic and robotic Frey procedures are evolving)
03
Wide opening of the lesser sac, full mobilisation of the pancreatic head and identification of the main duct
04
Coring out 4-12 g of fibrotic head parenchyma anterior to the intrapancreatic bile duct (preserving a thin posterior shell)
05
Longitudinal pancreaticojejunostomy along the entire pancreatic duct with a 60 cm Roux-en-Y jejunal limb
06
Postoperative care: nasogastric decompression 1-3 days, early enteral feeding, octreotide for selected patients to reduce fistula risk
07
Long-term: alcohol and smoking cessation, pancreatic enzyme replacement, diabetes management, annual surveillance

Which Department to Visit?

You can visit our Genel Cerrahi department for these complaints. Our specialist physicians will create the most suitable treatment plan for you.

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Health Disclaimer: The information on this page is prepared for general informational purposes only. It does not replace medical diagnosis and treatment. Please consult your physician for your complaints. Saygı Hospital does not accept responsibility for actions taken based on the information on this page.