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


  • L. Soundararajan Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
  • Srinivasan Ulagendraperumal Department of Surgical Gastroenterology, Government Kilpauk Medical College, Chennai, Tamil Nadu, India
  • R. Prabhakaran Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India
  • O. L. Naganathbabu Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Madras Medical College, Chennai, Tamil Nadu, India



Chronic calcific pancreatitis, Exocrine endocrine deficiency, Freys, Head coring, Quality of life


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. 


Ákos P. Pancreatic head mass: How can we treat It? chronic pancreatitis: conservative treatment. JOP. 2000;1:143-53.

Zhao X, Cui N, Wang X, Cui Y. Surgical strategies in the treatment of chronic pancreatitis: An updated systematic review and meta-analysis of randomized controlled trials. Medicine. 2017;96(9):6220.

Evans JD, Wilson PG, Carver C, Bramhall SR, Buckels JA, Mayer AD, et al. Outcome of surgery for chronic pancreatitis. Bri J Surg. 1997;84(5):624-9.

Ho HS, Frey CF. The Frey procedure: local resection of pancreatic head combined with lateral pancreaticojejunostomy. Archiv Surg. 2001;136(12):1353-8.

Cahen DL, Gouma DJ, Nio Y, Rauws EA, Boermeester MA, Busch OR, et al. Endoscopic versus surgical drainage of the pancreatic duct in chronic pancreatitis. N Engl J Med. 2007;356:676-84.

Frey CF, Amikura K. Local resection of the head of the pancreas combined with longitudinal pancreaticojejunostomy in the management of patients with chronic pancreatitis. Annal Surg. 1994;220(4):492.

Negi S, Singh A, Chaudhary A. Pain relief after Frey's procedure for chronic pancreatitis. Bri J Surg. 2010;97(7):1087-95.

Frey CF, Smith GJ. Description and rationale of a new operation for chronic pancreatitis. Pancreas. 1987;2(6):701-7.

Jensen MP, Turner JA, Romano JM, Fisher LD. Comparative reliability and validity of chronic pain intensity measures. Pain. 1999;83(2):157-62.

World Health Organization. Traitement de la douleurcancéreuse. Geneva, Switz: World Health Organization; 1987.

American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes care. 2014;37(1):81-90.

Hays, RD. The Medical Outcomes Study (MOS) Measures of Patient Adherence. Retrieved April 19, 2004, Available at: surveys/MOS.adherence.measures.pdf. Accessed on 06 January 2019.

Ramesh H. Chronic pancreatitis: The case for surgery. J Dige Endo. 2012;3(5):53-5.

Nealon WH, Townsend Jr CM, Thompson JC. Operative drainage of the pancreatic duct delays functional impairment in patients with chronic pancreatitis. A prospective analysis. Ann Surg. 1988;208:321.

Nealon WH, Thompson JC. Progressive loss of pancreatic function in chronic pancreatitis is delayed by main pancreatic duct decompression. A longitudinal prospective analysis of the modified puestow procedure. Annal Surg. 1993;217(5):458.

Roch A, Teyssedou J, Mutter D, Marescaux J, Pessaux P. Chronic pancreatitis: A surgical disease? Role of the Frey procedure. World J Gastroint Surg. 2014;6(7):129.

Gestic MA, Callejas-Neto F, Chaim EA, Utrini MP, Cazzo E, Pareja JC. Surgical treatment of chronic pancreatitis using Frey's procedure: a Brazilian 16-year single-centre experience. HPB. 2011;13(4):263-71.

Aimoto T, Uchida E, Matsushita A, Kawano Y, Mizutani S, Kobayashi T. Long-term outcomes after Frey's procedure for chronic pancreatitis with an inflammatory mass of the pancreatic head, with special reference to locoregional complications. J Nippon Med School. 2013;80(2):148-54.

Falconi M, Bassi C, Casetti L, Mantovani W, Mascetta G, Sartori N, et al. Long-term results of Frey’s procedure for chronic pancreatitis: a longitudinal prospective study on 40 patients. J Gastroint Surg. 2006;10(4):504-10.

Ho HS, Frey CF. Current approach to the surgical management of chronic pancreatitis. Gastroent. 1997;5:128-36.






Original Research Articles