Frey Procedure and Distal Pancreatectomy

Frey Procedure: Failure of the Puestow procedure may be caused by poor drainage of the head of the pancreas. To improve drainage of the pancreatic head, the Puestow procedure may be combined with removal of part of the head of the pancreas resulting in what is called the Frey procedure). This operation is done by coring out the diseased portion of the head of the pancreas to improve drainage of ducts in the head of the pancreas that would not otherwise be drained doing the traditional Puestow operation. Dr. Frey has reported good outcome with this procedure and can be done without increasing the risks of the Puestow procedure.

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Distal Pancreatectomy

The term distal pancreatectomy describes resection of variable amounts of the body and tail of the pancreas. Partial pancreatic resection is recommended for patients with diffuse (moderate to severe) parenchyma disease without ductal dilation, especially in the tail and body. Local resection of major pancreatic sites of involvement may be sufficient for those patients with regional disease, whereas a 95% distal resection is recommended for patients with diffuse disease. Ninety-five percent distal pancreatectomy entails removal of the spleen and almost all of the pancreas, except for a thin rim of tissue within the "C" loop of the duodenum. Splenic preservation is attempted, but often fails because dissection of splenic vessels from the chronically inflamed and scarred pancreas is extremely difficult. This procedure provides pain relief for 75–80% of patients and has a mortality rate less than 5%.

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