Impact of prior interventional treatment on the complications after Frey procedure for chronic pancreatitis.

PURPOSE: Chronic pancreatitis is an inflammatory disease responsible for pain partially explained by pancreatic duct dilatation. Early surgery has become the treatment of choice for hypertrophic pancreatic head with main pancreatic duct dilatation. Frey procedure (FP), combining both surgical resection and decompression, is one of the standard surgical procedures. However, a "step-up approach" with endoscopic or limited surgical procedures is still frequently proposed before referring to expert pancreatic centres. The aim of the study was to evaluate the impact of a prior treatment on post-operative complications of FP. METHODS: All 61 consecutive patients who underwent FP between 2006 and 2017 were included. Perioperative data and outcomes were analyzed and compared according to the presence of a prior treatment. RESULTS: Twenty-four patients did not receive any prior treatment and thirty-seven patients had a prior endoscopic or limited surgical treatment. Preoperative data and outcomes were similar between the 2 groups. The rate of biliary derivation during FP was significantly higher in the group without prior endoscopic procedure. A prior treatment was not a risk factor for major morbidity (Clavien grade ≥ III). CONCLUSIONS: A first attempt of endoscopic or limited surgical procedures before FP may not influence post-operative complications. Even if not recommended, a "step-up approach" proposing a first less invasive treatment could still be proposed to the patients who want to delay a morbid surgical procedure.

Surgical treatment of esophageal perforations: the importance of a primary repair.

PURPOSE: The aim of the current study was to evaluate the outcome after primary repair in comparison to other surgical treatments and the advantage of reinforcing the sutures with an absorbable polyglactin 910 prosthesis. METHODS: All esophageal perforations surgically managed in this institution from January 1985 through April 2009 (n = 40) were retrospectively analyzed. Patients that underwent surgery with primary sutures (group A, n = 24) were compared with patients that received other surgical procedures (group B, n = 16). The time to initiate treatment (within or after the first 24 h) and if the suture was reinforced with a polyglactin 910 mesh were also analyzed in group A patients. RESULTS: The outcome was more favorable in group A than group B in terms of time in the intensive care unit (p = 0.005), and rate of reoperation (p = 0.005). There was no difference in the outcome after the primary suture with or without mesh reinforcement, although the rate of fistulization was lower in patients with a mesh (17 vs. 50 %, p = 0.19). CONCLUSIONS: Primary repair has a better outcome than other surgical treatment, even when performed more than 24 h after symptom onset, but not later than 48 h. Reinforcing the sutures with an absorbable polyglactin 910 mesh therefore seems to improve the outcome.