J W Maher1, F C Johlin, D Pearson. 1. Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242, USA.
Abstract
BACKGROUND: The study was undertaken to quantitate the effects of thoracoscopic splanchnic nerve resection (SPL) on pain from chronic pancreatitis. METHODS: Patients with chronic pancreatitis pain completed an analog pain scale before operation and at postoperative visits. Midepigastric and left-sided pain was treated with left SPL; right-sided pain was treated with right-sided SPL. If pain recurred on the contralateral side, the patient underwent contralateral SPL. RESULTS: Fifteen patients underwent SPL. Eleven patients required daily narcotics for relief of pain before operation. Eight patients had unilateral SPL, whereas seven ultimately had a bilateral operation (median follow-up, 18 months). Fourteen patients had constant pain before operation, which decreased to a mean of 2.8 attacks per month (p < 0.0001). Before operation, the "worst pain within last two months" was 9.1 on pain scale (range, 0 for no pain, to 11 for constant pain). After operation this decreased 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 interfering with daily activities" decreased from 7.3 before operation to 2.3 after operation (p < 0.0001). Seven patients (46%) no longer require narcotics and are classified as having had good results. Five patients (33%) are classified as improved and have had a major reduction in narcotic needs. Three have had no significant pain relief and are classified as having had poor results. CONCLUSIONS: Thoracoscopic SPL offers substantial promise in the therapy of pain from chronic pancreatitis.
BACKGROUND: The study was undertaken to quantitate the effects of thoracoscopic splanchnic nerve resection (SPL) on pain from chronic pancreatitis. METHODS:Patients with chronic pancreatitis pain completed an analog pain scale before operation and at postoperative visits. Midepigastric and left-sided pain was treated with left SPL; right-sided pain was treated with right-sided SPL. If pain recurred on the contralateral side, the patient underwent contralateral SPL. RESULTS: Fifteen patients underwent SPL. Eleven patients required daily narcotics for relief of pain before operation. Eight patients had unilateral SPL, whereas seven ultimately had a bilateral operation (median follow-up, 18 months). Fourteen patients had constant pain before operation, which decreased to a mean of 2.8 attacks per month (p < 0.0001). Before operation, the "worst pain within last two months" was 9.1 on pain scale (range, 0 for no pain, to 11 for constant pain). After operation this decreased 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 interfering with daily activities" decreased from 7.3 before operation to 2.3 after operation (p < 0.0001). Seven patients (46%) no longer require narcotics and are classified as having had good results. Five patients (33%) are classified as improved and have had a major reduction in narcotic needs. Three have had no significant pain relief and are classified as having had poor results. CONCLUSIONS: Thoracoscopic SPL offers substantial promise in the therapy of pain from chronic pancreatitis.
Authors: Yama Issa; Usama Ahmed Ali; Stefan A W Bouwense; Hjalmar C van Santvoort; Harry van Goor Journal: Surg Endosc Date: 2013-09-06 Impact factor: 4.584