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Head coring for chronic calcific pancreatitis without pancreatic head mass: Short-term outcome analysis
Rajamahendran Rajendran1, Anbalagan Amudhan2, Prabhakaran R2, Benet Duraisamy2, Rajendran Vellaisamy3, Kannan D4, Chandramohan SM5
1Post Graduate in Surgical Gastroenterology, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
2Assistant Professor in Surgical Gastroenterology, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
3Post graduate in Surgical Gastroenterology, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General hospital, Chennai, Tamil Nadu, India.
4Professor of Surgical Gastroenterology, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.
5Director of Surgical Gastroenterology, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital, Chennai, Tamil Nadu, India.

Article ID: 100024IJHPDRR2014
doi:10.5348/ijhpd-2014-24-OA-12

Address correspondence to:
Professor D. Kannan
Madras Medical College, Institute of Surgical Gastroenterology, Rajiv Gandhi Government General Hospital
Chennai, Tamil Nadu
India
Phone: 09787387183/09444878183
Email: minnalraja@gmail.com

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How to cite this article
R Rajamahendran, Amudhan A, Prabhakaran R, Duraisamy B, Vellaisamy R, Kannan D, Chandramohan SM. Head coring for chronic calcific pancreatitis without pancreatic head mass: Short-term outcome analysis. Int J Hepatobiliary Pancreat Dis 2014;4:62–69.


Abstract
Aims: Intolerable abdominal pain is the main cause which brings the patients with chronic calcific pancreatitis to the surgeon. As pancreatic head is the pacemaker of pain in chronic pancreatitis coring out the head even in the absence of inflammatory head mass provides better pain relief.
Materials and Methods: This retrospective cum prospective study analyzed the outcome of Frey procedure in chronic calcific pancreatitis patients without inflammatory head mass. Methods. For the period between 2010 and 2013, 140 patients with chronic pancreatitis underwent Frey procedure for intractable abdominal pain. Of them 80 patients without pancreatic head mass were included in the study. The mean follow-up was six months. Using visual analogue scale score pain was analyzed both preoperatively and postoperatively. Endocrine and exocrine insufficiencies are also analyzed.
Results: There was no 30-day mortality. Statistical analysis showed significant improvement of pain score. The improvement of pain score in the patients without head mass is comparable to the patients with head mass for whom Frey procedure was done. Though there is improvement in endocrine and exocrine insufficiency they are not statistically significant as per chi-square test.
Conclusion: This study shows that even in the patients with no pancreatic head mass, the head coring pancreatico jejunostomy procedure described by Frey provides a better quality of life and better pain relief with acceptable morbidity and nil mortality. Head coring procedure can be therefore strongly recommended for pain relief even in pancreatitis without head mass.

Keywords: Chronic calcific pancreatitis, Frey procedure, Head coring, Non-head mass CCP, Pain score, Pancreatico Jejunostomy

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Author Contributions:
Rajamahendran Rajendran – Substantial contributions to conception and design, Acquisition of data, Analysis and interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Anbalagan Amudhan – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Prabhakaran R. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Benet Duraisamy – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Rajendran Vellaisamy – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Kannan D. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Chandramohan S.M. – Analysis and interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of submission
The corresponding author is the guarantor of submission.
Source of support
None
Conflict of interest
Authors declare no conflict of interest.
Copyright
© 2014 Rajamahendran Rajendran et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.



About The Authors

Rajamahendran Rajendran is Junior Resident in Surgical Gastroenterology, Institute of Surgical Gastroenterology at Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai. He earned undergraduate degree (MBBS) from Government Kilpauk Medical College, Chennai and postgraduate degree (MS General Surgery) from Government Kilpauk Medical College, Chennai. He has Acquired Mrcs (Edinburgh) in the Year 2008, Completed Fellowship in Minimal Access Surgery in the Year 2008 under Amasi. He has published a case report of Embryonal rhabdomyosarcoma Liver in a 16 year old boy in International Journal of Hepatobiliary and Pancreatic Diseases and authored 8 books for undergraduates and 3 books for postgraduate students. His research interests include pancreatic cancer and chronic calcific pancreatitis. Email: minnalraja@gmail.com



Amudhan Anbalagan is the Senior Assistant Professor in Surgical Gastroenterology, Institute of Surgical Gastroenterology at Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai. He earned undergraduate degree (MBBS) from Stanley Medical College, Chennai and postgraduate degree (MS General Surgery) from Madras Medical College, Chennai and MCh Surgical Gastroenterology from Stanley Medical College, Chennai. He has published four research papers in national and international academic journals. His research interests include hepatobiliary and pancreatic surgeries. He has special interest in laparoscopic surgery.



Prabhakaran R is Assistant Professor at Madras Medical College in Surgical Gastroenterology, Institute of Surgical Gastroenterology Rajiv Gandhi Government Hospital, Chennai, India. He earned the undergraduate degree (MBBS) and Postgraduate degree (MS General Surgery) from Madurai Medical College, Madurai and superspeciality degree MCh Surgical Gastroenterology (Gold Medalist) from Stanley Medical College, Chennai, India. He has published two research papers in national and international academic journals. His research interests include hepatobiliary and pancreatic surgery. He is specialized in advanced laparoscopic gastrointestinal surgery.



Benet Duraisamy is Assistant Professor in Surgical Gastroenterology, Institute of Surgical Gastroenterology at Madras Medical College, Rajiv Gandhi Government General Hospital, Chennai, India. He earned undergraduate degree from Stanley medical College, Chennai, India and MCh Surgical gastroenterology from Madras Medical College, Chennai, India. His research interests include hepatobiliary, upper gastrointestinal and colorectal surgeries. He has special interest in gastrointestinal malignancies.



Rajendran Vellaisamy is Junior Resident in Madras Medical College in Surgical Gastroenterology, Institute of Surgical Gastroenterology. He earned undergraduate degree from Madurai Medical College and postgraduate degree from Kilpauk medical College, Chennai, India. His research interests include chronic pancreatitis, hilar cholangiocarcinoma and liver resection.



Kannan D is Professor of Surgical gastroenterology in Institute of Surgical Gastroenterology, Madras Medical College, Rajiv Gandhi General Hospital, Chennai, India. He completed his MCh Surgical gastroenterology from Madras medical College, He qualified his FRCS from UK. He has published a lot of articles in National and International Journals. His special field of interest includes liver resection and pancreatic cancer surgeries. He has done more than 200 Whipple's Procedure in his carrier.



Chandramohan S. M. is the Director and Head, Institute of Surgical Gastroenterology, Madras Medical College, Rajiv Gandhi General Hospital, Chennai, India. Presently, he is the Secretary, Indian Association of Surgical Gastroenterologis. He completed his MS General Surgery (Gold Medal) from Tanjore Medical college, Tanjore, India. He completed MCh Surgical gastroenterology from Madras Medical College, He has published more than 50 articles in National and International Journals. He has authored Upper gastrointestinal Chapters in a lot of textbooks. His special field of interest includes Upper GI surgery. He has done a lot of research and innovative works in corrosive stricture esophagus. He has great records in dealing with complex upper gastrointestinal works. His special field of interest include Gastric Cancer in India.