Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis.

To denervate the pancreas of sensory afferents, 15 patients with intractable pain of chronic alcohol induced pancreatitis underwent left transthoracic splanchnicectomy with concomitant bilateral truncal vagotomy. All were malnourished and 11 were addicted to opiates. No respite had been obtained from 33 previous operative procedures. Each patient experienced almost immediate pain relief. Five, however, later had return of pain, but only to the right epigastrium. These five then underwent right transthoracic splanchnicectomy, after which four noted complete and apparently permanent disappearance of pain. In those 14 with a successful outcome there has been a 29 per cent mean increase in body weight, break of hard drug addition in ten of the 11 so afflicted, and return to gainful work or a relatively normal lifestyle in all 14 at a mean follow-up of 16 months. Although 11 of the 14 do have delayed gastric emptying, only one has required a drainage procedure. There have been no other late complications. This approach for control of incapacitating pain in chronic pancreatitis is both safe and simple and at the same time it appears to be reasonably reliable.