Quality of life after bilateral thoracoscopic splanchnicectomy: long-term evaluation in patients with chronic pancreatitis.
We prospectively evaluated quality of life and visual analogue scale pain scores after bilateral thoracoscopic splanchnicectomy in 55 patients with small-duct chronic pancreatitis and abdominal pain. The perioperative morbidity rate was 11% and there were no perioperative deaths. Four late deaths occurred (7%), and three patients were lost to follow-up. Patients were divided into those who had prior operative or endoscopic interventions (N = 38) and those who did not (N = 17). Preoperatively there were no significant differences between the two groups with regard to age, sex, etiology, pain score, or narcotic use. Pain score, narcotic use, and symptoms scales improved significantly in both groups at 3 and 6 months postoperatively (P < 0.0001). The group with no prior surgical or endoscopic intervention did significantly better initially (P < 0.007), and the improvements in their quality-of-life and pain scores continued for the remainder of the study. In contrast, quality-of-life and pain scores in patients who had undergone prior surgical or endoscopic intervention returned to baseline by 12 months postoperatively and remained poor throughout the remainder of the study. Bilateral thoracoscopic splanchnicectomy appears to work best in patients who have had no prior operative or endoscopic interventions.
Howard
Thomas J
TJ
Department of Surgery, Indiana University School of Medicine, Emerson Hall #523, 545 Barnhill Drive, Indianapolis, IN 46202, USA. tjhoward@iupui.edu
Swofford
John B
JB
Wagner
Dennis L
DL
Sherman
Stuart
S
Lehman
Glen A
GA
D015746:Abdominal Pain / Q000209:etiology / Q000503:physiopathology / Q000601:surgery*; D000328:Adult; D016022:Case-Control Studies; D016009:Chi-Square Distribution; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery*; D010195:Pancreatitis / Q000150:complications* / Q000175:diagnosis; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D011788:Quality of Life; D012016:Reference Values; D013153:Splanchnic Nerves / Q000601:surgery*; D018709:Statistics, Nonparametric; D013562:Sympathectomy / Q000379:methods; D013906:Thoracoscopy / Q000379:methods*; D016896:Treatment Outcome