Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis.
BACKGROUND
The management of opiate-dependent intractable abdominal pain caused by chronic pancreatitis remains challenging. The published series on the role, safety, feasibility, and efficacy of thoracoscopic splanchnicectomy are reviewed.


METHODS
The MEDLINE, EMBASE, and PREMEDLINE databases were searched, and relevant English language publications were systematically retrieved. Data were pooled by two independent reviewers.


RESULTS
Between 1994 and 2006, 302 patients were featured in 16 reports. The reports described 202 procedures as bilateral and 100 as unilateral. These procedures were associated with rates of 16.6% for morbidity, 1.3% for conversion to thoracotomy, 1.3% for reoperation to manage complications, and 0% for mortality. The mean postoperative hospital stay was 2.7 days. The mean success rate was 90% up to 6 months of follow-up evaluation, 75% at >6 to 15 months of follow-up evaluation, and 49% at >15 months to 5.7 years of follow-up evaluation. Further intervention for pain relief was required for 12.9% of the patients.


CONCLUSIONS
Splanchnicectomy reduces pain and improves quality of life for patients with chronic pancreatitis. Patient selection determines success rates, but the early good results achieved decline with time elapsed after thoracoscopic splanchnicectomy.
Baghdadi
Saleh
S
Department of Surgery, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL, UK.
Abbas
M Hasan
MH
Albouz
Farah
F
Ammori
Basil J
BJ
D015746:Abdominal Pain / Q000503:physiopathology / Q000517:prevention & control; D000328:Adult; D001340:Autonomic Nerve Block / Q000379:methods; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010148:Intractable Pain / Q000209:etiology / Q000601:surgery*; D010166:Palliative Care / Q000379:methods*; D050500:Pancreatitis, Chronic / Q000150:complications / Q000175:diagnosis / Q000601:surgery*; D017060:Patient Satisfaction; D011446:Prospective Studies; D013153:Splanchnic Nerves / Q000601:surgery*; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D016896:Treatment Outcome