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15 June 2020 : Case report  Japan

Laparoscopic Frey’s Procedure for Chronic Pancreatitis in a Japanese Patient

Unusual clinical course

Takayoshi Nakajima12ABCDEF, Takeshi Fukumoto34ABCDEFG*, Tadashi Tsukamoto1ABCD, Akishige Kanazawa1ABCD, Shintaro Kodai1ABCD, Yoshihiro Mori1ABCD

DOI: 10.12659/AJCR.924206

Am J Case Rep 2020; 21:e924206

Abstract

BACKGROUND: Chronic pancreatitis is a slowly progressive inflammatory disease, affecting patients’ quality of life due to chronic pain as well as endocrine and exocrine pancreatic insufficiency. Patients often choose surgery if medical and endoscopic interventions fail. Surgical approaches for chronic pancreatitis can be categorized as follows: resection of the diseased gland, diversion and drainage of the dilated pancreatic duct, or a combination of these approaches. Frey’s procedure, which involves resection and drainage by longitudinal pancreaticojejunostomy and coring out of the pancreatic head, is reserved for patients with debilitating pain. Although laparoscopic surgery is gaining popularity in recent years due to its noninvasiveness and cosmetic benefit, few reports describe performing Frey’s procedure laparoscopically.

CASE REPORT: A 36-year-old Japanese female with chronic pancreatitis complained of back pain and pain in the left upper quadrant abdomen. Plain computed tomography of her abdomen revealed a dilated main pancreatic duct containing diffuse calculi extending to the pancreatic parenchyma. Laboratory findings, including amylase level, were within normal ranges. She was diagnosed with chronic pancreatitis, and subsequently underwent a laparoscopic Frey’s procedure. To our knowledge, we are the first to improve operative field visibility by using a Penrose drain to move the stomach from the line of sight. Postoperatively, the patient did well and was discharged 10 days after surgery. She remained symptom-free without medications for 80 months.

CONCLUSIONS: Due to its noninvasive nature and cosmetic advantages, laparoscopic Frey’s procedure may be an attractive therapeutic option for chronic pancreatitis.

Keywords: Abdominal Pain, Laparoscopy, Pancreatitis, Chronic, Japan, Pancreaticojejunostomy

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American Journal of Case Reports eISSN: 1941-5923
American Journal of Case Reports eISSN: 1941-5923