Frey procedure with distal pancreatectomy: How to do it

Abstract Although the Frey procedure effectively treats chronic pancreatitis, late relapse can occur in the pancreatic tail. This paper details the essential steps of combining the Frey procedure with distal pancreatectomy (Frey + DP) to address this issue. The key surgical steps include distal pancreatectomy, longitudinal opening of the main pancreatic duct, pancreatic head coring, and longitudinal pancreaticojejunostomy. Comparing the outcomes of nine Frey + DP and 13 Frey-alone patients (2016–2024), Frey + DP had significantly longer operative times and higher estimated blood loss. However, the postoperative hospital stay, mortality, 1-year pain recurrence, and new-onset diabetes were comparable between the two groups. Although more invasive, Frey + DP definitively treats concurrent severe tail disease, mitigating the risk of late relapse and requiring difficult reoperations. Frey + DP is a safe and effective approach for patients with chronic pancreatitis with inflammatory lesions in both the pancreatic head and tail.