Bilateral thoracoscopic splanchnicectomy: Effects on pancreatic pain and function

Objective To evaluate prospectively the effect of bilateral thoracoscopic s planchnicectomy on pancreatic pain and function, Summary Background Data Severe pain is often the dominant symptom in pancre atic disease, despite a wide variety of methods used for symptom relief, Re finement of thoracoscopic technique has led to the introduction of thoracos copic splanchnicectomy in the treat ment of pancreatic pain. Methods Forty-four patients, 23 with pancreatic cancer and 21 with chronic pancreatitis, were included in the study and underwent bilateral thoracosco pic splanchnicectomy. Effects on pain (visual analogue scale) and pancreati c function (standard secretin test, basal serum glucose, plasma insulin, an d 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 mont hs for cancer and 43 months for pancreatitis. Pain relief was evident in th e first postoperative week and was sustained during follow-up, the average pain score being reduced by 50%. All patients showed a decrease in consumpt ion of analgesics. Neither endocrine nor exocrine function was adversely af fected by the procedure. Conclusions Bilateral thoracoscopic splanchnicectomy is beneficial in the t reatment of pancreatic pain and is not associated with deterioration of pan creatic function.