Long-term results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis

Br J Surg. 2002 Feb;89(2):158-62. doi: 10.1046/j.0007-1323.2001.01988.x.

Abstract

Background: The management of pain in patients with chronic pancreatitis is difficult. The aim of this prospective study was to evaluate the early and long-term pain relief provided by bilateral thoracoscopic splanchnicectomy.

Methods: From August 1995 to August 1999, 44 patients with chronic pancreatitis underwent bilateral thoracoscopic splanchnicectomy. Data were collected prospectively. Thirty-six patients required opioids. Pain intensity was registered before operation and at regular intervals after surgery by means of a visual analogue scale (VAS). Use of analgesics (opioids; non-steroidal anti-inflammatory drugs and acetaminophen; no analgesics or aminocetophen) was noted before and after splanchnicectomy. Median follow-up was 36 (range 12-60) months.

Results: The procedure was technically successful in 40 patients. Thirty-six patients had no complications. Eleven of 24 patients who have been followed up for 24 months or more had a significantly reduced VAS score at 2 years (median (range) 8.5 (7-10) versus 2.5 (0-5); P < 0.01). The cumulative rate of pain relief was 46 per cent 48 months after splanchnicectomy.

Conclusion: Bilateral thoracoscopic splanchnicectomy alleviated pain in patients with chronic pancreatitis. It was associated with a low morbidity rate and no deaths. Pain eventually recurred in approximately 50 per cent.

MeSH terms

  • Adolescent
  • Adult
  • Chronic Disease
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Middle Aged
  • Narcotics / therapeutic use
  • Pain, Postoperative / prevention & control
  • Pancreatitis / surgery*
  • Postoperative Complications / etiology*
  • Prospective Studies
  • Recurrence
  • Splanchnic Nerves / surgery*
  • Thoracoscopy / methods*
  • Time Factors

Substances

  • Narcotics