Bilateral thoracoscopic splanchnicectomy: effects on pancreatic pain and function.
OBJECTIVE
To evaluate prospectively the effect of bilateral thoracoscopic splanchnicectomy on pancreatic pain and function.


BACKGROUND
Severe pain is often the dominant symptom in pancreatic disease, despite a wide variety of methods used for symptom relief. Refinement of thoracoscopic technique has led to the introduction of thoracoscopic splanchnicectomy in the treatment of pancreatic pain.


METHODS
Forty-four patients, 23 with pancreatic cancer and 21 with chronic pancreatitis, were included in the study and underwent bilateral thoracoscopic splanchnicectomy. Effects on pain (visual analogue scale) and pancreatic function (standard secretin test, basal serum glucose, plasma insulin, and C-peptide) were measured.


RESULTS
Four patients (9%) required thoracotomy because of bleeding. There were no procedure-related deaths. The mean duration of follow-up was 3 months for cancer and 43 months for pancreatitis. Pain relief was evident in the first postoperative week and was sustained during follow-up, the average pain score being reduced by 50%. All patients showed a decrease in consumption of analgesics. Neither endocrine nor exocrine function was adversely affected by the procedure.


CONCLUSIONS
Bilateral thoracoscopic splanchnicectomy is beneficial in the treatment of pancreatic pain and is not associated with deterioration of pancreatic function.
Ihse
I
I
Department of Surgery, Lund University Hospital, Sweden.
Zoucas
E
E
Gyllstedt
E
E
Lillo-Gil
R
R
Andrén-Sandberg
A
A
D000368:Aged; D000369:Aged, 80 and over; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000503:physiopathology*; D010179:Pancreas / Q000503:physiopathology*; D010186:Pancreatic Function Tests; D010190:Pancreatic Neoplasms / Q000503:physiopathology* / Q000628:therapy*; D010195:Pancreatitis / Q000503:physiopathology* / Q000628:therapy*; D011446:Prospective Studies; D013153:Splanchnic Nerves / Q000601:surgery*; D013906:Thoracoscopy