What is the typical duration of the Frey procedure (Frey's procedure)?

Frey Procedure Duration

The Frey procedure typically takes 310 minutes (approximately 5 hours) when performed via open approach, with laparoscopic approaches requiring longer operative times of approximately 420 minutes (7 hours). 1

Operative Time by Surgical Approach

Open Frey Procedure

• Median operative time: 310 minutes (range 179-515 minutes) for the traditional open approach 1
• The open technique generally allows for faster completion due to direct visualization and easier access to the pancreatic head 1

Laparoscopic Frey Procedure

• Median operative time: 420 minutes (range 290-685 minutes) for the laparoscopic approach 1
• The minimally invasive approach requires additional time for port placement, laparoscopic dissection, and intracorporeal suturing 1
• A smaller series reported shorter laparoscopic times with a median of 130 minutes (range 100-160 minutes), though this likely reflects highly selected cases at an experienced center 2
• Approximately 90% of laparoscopic cases can be completed without conversion to open surgery 1

Factors Affecting Operative Duration

The complexity of the Frey procedure stems from the coring of the inflamed pancreatic head, which is the most technically demanding and time-consuming component of the operation. 3

Technical Considerations

• Coring out the enlarged, inflamed pancreatic head requires meticulous dissection and is often associated with considerable bleeding 3
• Use of specialized instruments like the harmonic scalpel can reduce operative time by decreasing bleeding and making the dissection technically easier 3
• The procedure involves both resection (pancreatic head coring) and reconstruction (pancreaticojejunostomy), contributing to the overall duration 4

Comparative Context

• The Frey procedure demonstrates significantly shorter operative time compared to pancreaticoduodenectomy, which is an important advantage of this organ-preserving approach 5
• The Frey procedure also has shorter operative time compared to the Beger procedure (duodenum-preserving pancreatic head resection) 5

Clinical Implications

Despite the substantial operative time, the Frey procedure maintains an extremely low mortality rate of 0.4% and acceptable morbidity of 23.2%, making the time investment worthwhile for appropriate candidates 5. The longer duration should be factored into anesthesia planning and patient counseling, particularly for patients with significant comorbidities where prolonged anesthesia may pose additional risks 6.