[Bilateral splanchnicectomy by transhiatal approach in pain of pancreatic origin. 37 cases].
OBJECTIVE
Surgical splanchnicectomy remains a useful means to relieve pain induced by malignant tumours of the pancreas and chronic pancreatitis. We report our experience in 37 patients.


METHODS
Between 1983 and 1993, 37 patients underwent transhiatal bilateral splanchnicectomy; 32 had a non-resectable adenocarcinoma and 5 chronic pancreatitis. In all cases, morphine had been required for pain relief.


RESULTS
Symptomatic pain relief was immediately achieved, with complete sedation in 84.3% of the cases. Prolonged antalgic effect continued for the survival period in 84.3%. Mean post-operative follow-up was 12.7 weeks corresponding to mean survival in 32 patients with pancreatic tumour. Post-operative mortality was 21.6% with no direct relationship with neurectomy. Specific morbidity related to pleural drainage was 10.8%.


CONCLUSIONS
Compared with other surgical procedures, trans-hiatal bilateral splanchnicectomy is a simple technique which can be performed whatever the stage of the locoregional tumour extension. In patients without an indication for exploratory laparoscopy, percutaneous chemical neurolysis is still indicated, even if the long-term result is less effective. In case of failure or technical impossibilities, thoracoscopic splanchnicectomy should be performed.
Bali
B
B
Département de Chirurgie digestive et de Cancérologie, CHU Carémeau, Nîmes.
Deixonne
B
B
Rzal
K
K
Sawhi
A
A
Squali
J
J
Poirée
G
G
Lapeyrie
H
H
D015746:Abdominal Pain / Q000209:etiology / Q000601:surgery*; D000230:Adenocarcinoma / Q000150:complications* / Q000401:mortality; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010148:Intractable Pain / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000150:complications* / Q000401:mortality; D010195:Pancreatitis / Q000150:complications*; D012189:Retrospective Studies; D013153:Splanchnic Nerves / Q000601:surgery*
Splanchnicectomie bilatérale par voie trans-hiatale dans les douleurs d'origine pancréatique. 37 observations.