Retrospective Study
Copyright ©The Author(s) 2016.
World J Gastroenterol. Dec 21, 2016; 22(47): 10415-10423
Published online Dec 21, 2016. doi: 10.3748/wjg.v22.i47.10415
Table 1 Clinical characteristics of patients
CharacteristicO Frey(n = 44)M Frey(n = 36)P value
Age (yr)46 ± 12.548 ± 8.40.560
Sex0.130
Male3533
Female93
Etiology0.720
Alcohol2221
Nicotine74
Idiopathic1511
Pain severity index3.84 ± 1.142.92 ± 1.470.020
Exocrine insufficiency300.580
Endocrine insufficiency14170.450
Morphologic characters
Stone of calcification39290.360
Large cavities (> 10 mm)7110.120
Gland enlargement (> 2 × normal)790.310
Severe organ complications
Obstruction of ductus choledochus020.200
Ascites00
Weight loss1390.650
M-ANNHEIM severity index0.060
A14
B2917
C1215
D20
E00
Indication for surgery
Intractable pain38280.315
Recurrent episodes22
Bile duct stenosis02
Risk of malignancy44
Follow-up time (mo)50.3 ± 17.348.7 ± 15.60.670
Table 2 Short-term results of two types of Frey’s procedures
O FreyM FreyP value
Operating time (min)230 ± 79258 ± 650.095
Blood loss (mL)111 ± 7998 ± 890.492
Morbidity
Pancreatic fistula, B and C020.199
Postoperative hemorrhage111
Pulmonary infection211
Abdominal infection441
Mortality00\
Postoperative hospital stay (d)8.3 ± 3.18.6 ± 4.70.698
Table 3 Postoperative risk factors and condition of pancreatic function
Postoperative conditionO Frey(n = 44)M Frey(n = 36)P value
Alcohol abuse340.387
Nicotine abuse520.307
New-onset exocrine insufficiency870.886
Worsen exocrine insufficiency111.000
New-onset endocrine insufficiency230.404
Worsen endocrine insufficiency530.475
Table 4 Postoperative pain relief after two types of Frey’s procedures
History of surgeryPain symptomO FreyM FreyP value
< 5 yrPositive11170.032
Negative2211
> 5 yrPositive650.551
Negative53
Table 5 QoL after two types of Frey’s procedures
Follow-up results of QoL assessmentO FreyM FreyP value
Functional scales
Physical95910.113
Role95930.322
Cognitive87830.241
Emotional69580.047
Social66530.052
Global QoL62530.115
Symptom scales
Fatigue28390.028
Nausea and vomiting00
Pain18280.153
Dyspnea00
Sleep disturbance410.294
Appetite loss30370.297
Constipation310.683
Diarrhea21260.445
Financial impact32420.120
Table 6 Impact of M-ANNHEIM severity index on pain relief after two types of Frey’s procedures
History of surgerySurgeryPain symptomM-ANNHEIM severity
P value
A, BC-E
< 5 yrO FreyPositive740.794
Negative157
M FreyPositive1160.591
Negative65
> 5 yrO FreyPositive420.576
Negative41
M FreyPositive230.500
Negative21
Table 7 M-ANNHEIM scoring system for the grading of clinical features of chronic pancreatitis
Clinical featuresPoints
Patient report of pain
No pain without therapy(patient reports requiring no pain medication)0
Recurrent acute pancreatitis(patient reports freedom from pain between attacks of acute pancreatitis)1
No pain with therapy(patient reports freedom from pain with pain medication or endoscopic intervention)2
Intermittent pain(patient reports intermittent pain-free episodes, either with or without therapy; possibly additional attacks of acute pancreatitis)3
Continuous pain(patient reports absence of pain-free episodes, either with or without therapy; possibly additional attacks of acute pancreatitis)4
Pain control1
No medication0
Use of non-opioid drugs or use of mild opioids (WHO step 1 or 2)1
Use of potent opioids (WHO step 3) or endoscopic intervention2
Surgical intervention12
Pancreatic surgical intervention for any reason4
Exocrine insufficiency3
Absence of exocrine insufficiency0
Presence of mild, moderate, or unproven exocrine insufficiency not requiring enzyme supplementation (including patient reports of intermittent diarrhea)1
Presence of proven exocrine insufficiency (according to exocrine function tests) or presence of marked exocrine insufficiency defined as steatorrhea (> 7 g fac/24 h), normalized or markedly reduced by enzyme supplementation2
Endocrine insufficiency
Absence of diabetes mellitus0
Presence of diabetes mellitus4
Morphologic status on pancreatic imaging (according to the Cambridge classification)
Normal0
Equivocal1
Mild2
Moderate3
Marked4
Severe organ complication2 (not included in the Cambridge classification)
Absence of complications0
Presence of possibly reversible complication42
Presence of irreversible complications44
Table 8 M-ANNHEIM severity index of chronic pancreatitis
Severity indexSeverity levelPoint range
M-ANNHEIM AMinor0-5
M-ANNHEIM BIncreased6-10
M-ANNHEIM CAdvanced11-15
M-ANNHEIM DMarked16-20
M-ANNHEIM EExacerbated> 20