THORACOSCOPIC SPLANCHNICECTOMY FOR CHRONIC-PANCREATITIS PAIN

Background. The study was undertaken to quantitate the effects of thor acoscopic splanchnic nerve resection (SPL) on pain from chronic pancre atitis. Methods. Patients with chronic pancreatitis pain completed an analog pain scale before operation and at postoperative visits. Midepi gastric and left-sided pain was treated with left SPL; right-sided pai n was treated with right-sided SPL. If pain recurred on the contralate ral side, the patient underwent contralateral SPL. Results. Fifteen pa tients underwent SPL. Eleven patients required daily narcotics for rel ief of pain before operation. Eight patients had unilateral SPL, where as seven ultimately had a bilateral operation (median follow-up, 18 mo nths). Fourteen patients had constant pain before operation which decr eased to a mean of 2.8 attacks per month (p < 0.0001). Before operatio n, the ''worst pain within last two months'' was 9.1 on pain scab (ran ge, 0 for no pain to 11 for constant pain). After operation this decre ased 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 interferring with daily activities'' decreased from 7.3 before operation to 2.3 after operation (p < 0.0001). Seven patients (46%) n o longer require narcotics and are classified as having had good resul ts. Five patients (33%) are classified as improved and have had a majo r reduction in narcotic needs. Three have had no significant pain reli ef and are classified as having had poor results. Conclusions. Thoraco scopic SPL offers substantial promise in the therapy of pain from chro nic pancreatitis.