Extent of Pancreatic Fibrosis as a Determinant of Symptom Resolution After the Frey Procedure: A Clinico-pathologic Analysis

Objective: The aim of this study was to evaluate the association of histopathologic features of chronic pancreatitis and pain relief after the Frey procedure. Design: We retrospectively analyzed 35 patients who underwent the Frey procedure for chronic pancreatitis over a 5-year period (November 2005 to February 2011). Setting: Thirty-five patients with varied etiologies of chronic pancreatitis and persistent symptoms were referred to a multi-disciplinary pancreatitis clinic where a consensus decision to recommend surgery was established. The Frey procedure was then performed. Main outcome measures: We compared symptomatic outcomes with the degree of pancreatic fibrosis, duct dilatation, and presence of pancreatic duct stones based on a blinded evaluation of resected pancreatic tissue. Results: Symptom resolution was associated with severe or extensive (<75 %) fibrosis and absence of symptom resolution was associated with mild or minimal (<25 %) fibrosis (chi-squared, p value < 0. 05). Symptom resolution was associated with pancreatic duct >4 mm and absence of symptom resolution was associated with pancreatic duct ≤4 mm (chi-squared, p value < 0. 05). There was no difference in outcomes for patients with and without pancreatic duct stones. Conclusion: Symptom resolution after the Frey procedure is more likely in the setting of severe or extensive fibrosis due to chronic pancreatitis.