Frey's procedure is done for
Treatment of chronic pancreatitis Most of the patients can be managed medically. There is no single therapeutic agent that can relieve symptoms Endoscopic, radiological or surgical interventions are indicated mainly to relieve obstruction of the pancreatic duct, bile duct or the duodenum, or in dealing with complications (e.g. pseudocyst, abscess, fistula, ascites or variceal haemorrhage). Decompressing an obstructed pancreatic duct can provide pain relief in some patients (the assumption is that ductal hypeension causes the pain). Endoscopic pancreatic sphincterotomy might be beneficial in patients with papillary stenosis and a high sphincter pressure and pancreatic ductal pressure. Patients with a dominant pancreatic duct stricture and upstream dilatation may benefit by placement of a stent across the stricture. The stent should be left in for no more than 4-6 weeks as it will block. The complication rate is high, and less than two-thirds of patients experience pain relief, but those who do get relief may benefit from a surgical bypass. Pancreatic duct stones maybe extracted at ERCP, and this may sometimes be combined with extracorporeal shock wave lithotripsy. Pseudocysts may be drained internally under EUS guidance. Percutaneous or transgastric drainage of pseudocysts under ultrasound or CT guidance may be performed. The role of surgery is to overcome obstruction and remove mass lesions. Some patients have a mass in the head of the pancreas, for which either a pancreatoduodenectomy or a Beger procedure (duodenum-preserving resection of the pancreatic head) is appropriate. If the duct is markedly dilated, then a longitudinal pancreatojejunostomy or Frey procedure can be of value. The natural evolution of the disease may not be altered significantly, but around half the patients get long-term pain relief. The rare patient with disease limited to the tail will be cured by a distal pancreatectomy. Patients with intractable pain and diffuse disease may plead for a total pancreatectomy in the expectation that removing the offending organ will relieve their pain. How- ever, one should keep in mind that pancreatic function and quality of life are significantly impaired after this procedure, and the operative moality rate is not tril. Moreover, there is no guarantee of pain relief (approximately a third of patients get resolution, a third show some benefit, and a third see no benefit at all). Total pancreatectomy and islet auto- transplantation has been repoed in selected patients, but it is difficult to demonstrate any overall benefit. Ref: Bailey and love 27th edition Pgno : 1231
Meckel's diveicual
Auriculotemporal neuropathy
Ulcerative colitis
Chronic pancreatitis
Urology