Thoracoscopic splanchnicectomy for chronic pancreatitis pain.
BACKGROUND
The study was undertaken to quantitate the effects of thoracoscopic splanchnic nerve resection (SPL) on pain from chronic pancreatitis.


METHODS
Patients with chronic pancreatitis pain completed an analog pain scale before operation and at postoperative visits. Midepigastric and left-sided pain was treated with left SPL; right-sided pain was treated with right-sided SPL. If pain recurred on the contralateral side, the patient underwent contralateral SPL.


RESULTS
Fifteen patients underwent SPL. Eleven patients required daily narcotics for relief of pain before operation. Eight patients had unilateral SPL, whereas seven ultimately had a bilateral operation (median follow-up, 18 months). Fourteen patients had constant pain before operation, which decreased to a mean of 2.8 attacks per month (p < 0.0001). Before operation, the "worst pain within last two months" was 9.1 on pain scale (range, 0 for no pain, to 11 for constant pain). After operation this decreased to 5.1 (p < 0.002). "Current severity" of pain decreased from 6.5 before operation to 2.0 after operation (p < 0.0005). The "amount pain is interfering with daily activities" decreased from 7.3 before operation to 2.3 after operation (p < 0.0001). Seven patients (46%) no longer require narcotics and are classified as having had good results. Five patients (33%) are classified as improved and have had a major reduction in narcotic needs. Three have had no significant pain relief and are classified as having had poor results.


CONCLUSIONS
Thoracoscopic SPL offers substantial promise in the therapy of pain from chronic pancreatitis.
Maher
J W
JW
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Johlin
F C
FC
Pearson
D
D
D000293:Adolescent; D000328:Adult; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009294:Narcotics / Q000008:administration & dosage; D010146:Pain / Q000188:drug therapy / Q000209:etiology / Q000601:surgery*; D010147:Pain Measurement; D010195:Pancreatitis / Q000150:complications* / Q000401:mortality / Q000601:surgery; D013153:Splanchnic Nerves / Q000601:surgery*; D013906:Thoracoscopy
D009294:Narcotics