Abstract
We prospectively evaluated quality of life and visual analogue scale pain scores after bilateral thoracoscopic splanchnicectomy in 55 patients with small-duct chronic pancreatitis and abdominal pain. The perioperative morbidity rate was 11% and there were no perioperative deaths. Four late deaths occurred (7%), and three patients were lost to follow-up. Patients were divided into those who had prior operative or endoscopic interventions (N=38) and those who did not (N=17). Preoperatively there were no significant differences between the two groups with regard to age, sex, etiology, pain score, or narcotic use. Pain score, narcotic use, and symptoms scales improved significantly in both groups at 3 and 6 months postoperatively (P<0.0001). The group with no prior surgical or endoscopic intervention did significantlybetter initially (P< 0.007), and the improvements in their quality-of-life and pain scores continued for the remainder of the study. In contrast, quality-of-life and pain scores in patients who had undergone prior surgical or endoscopic intervention returned to baseline by 12 months postoperatively and remained poor throughout the remainder of the study. Bilateral thoracoscopic splanchnicectomy appears to work best in patients who have had no prior operative or endoscopic interventions.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Warshaw Al, Banks PA, Fernandez-del Castillo C. AGA Technical review on treatment of pain in chronic pancreatitis. Gastroenterology 1998;115:765–776.
Mallet-Guy P. La splanchnicectomie gauche dans le traitement des pancreatites chroniques. Presse Med 1943;51:145–146.
Mallet-Guy PA. Late and very late results of resections of the nervous system in the treatment of chronic relapsing pancreatitis. Am J Surg 1983;145:234–238.
Melki J, Riviere N, Roulee N, et al. Splanchnicectomie thoracique sous video-thoracoscopie. Presse Med 1993;22:1095–1097.
Worsey J, Ferson PF, Keenan RJ, et al. Thoracoscopic pancreatic denervation for pain control in irresectable pancreatic cancer. Br J Surg 1993;80:1051–1052.
Maher JW, Johlin FC, Pearson D. Thoracoscopic splanchnicectomy for chronic pancreatitis pain. Surgery 1996;120:603–610.
Cuschieri A, Shimi SM, Crothwaite G, Joypaul V. Bilateral endoscopic splanchnicectomy through a posterior thoracoscopic approach. J R Coll Surg Edinb 1994;39:44–47.
Bradley EL, Reynhout JA, Peer GL. Thoracoscopic splanchnicectomy for "small duct" chronic pancreatitis: Case selection by differential epidural analgesia. J GASTROINTEST SURG 1998;2:88–94.
Moodley J, Singh B, Shaik AS, et al. Thoracoscopic splanchnicectomy: Pilot evaluation of a simple alternative for chronic pancreatic pain control. World J Surg 1999;23:688–692.
Irmie CW, Menezes N, Carter CR. Diagnosis of chronic pancreatitis and newer aspects of pain control. Digestion 1999; 60(Suppl 1):111–113.
Bloechle C, Izbicki JR, Knoefel WT, et al. Quality of life in chronic pancreatitis—Results after duodenum-preserving resection of the head of the pancreas. Pancreas 1995;11:77–85.
Carlsson AM. Assessment of chronic pain I—Aspects of the reliability and validity of the visual analogue scale. Pain 1983;16:87–101.
Aaronson NK, Ahmedzai S, Bergman B, et al. The European Organization for Research and Treatment of Cancer QLQ-C30: A quality-of-life instrument for use in international clinical trials in oncology. J Natl Cancer Instit 1993; 85:365–376.
Malfertheiner P, Buchler MW, Stanescu A, Ditschuneit H. Pancreatic morphology and function in relationship to pain in chronic pancreatitis. Int J Pancreatol 1987;1:59–66.
Ammann RW, Bühler H, Münch R, et al. Differences in the natural history of idiopathic (nonalcoholic) and alcoholic chronic pancreatitis. A comparative long-term study of 287 patients. Pancreas 1987;2:368–377.
Lankisch PG, Andren-Sandberg A. Standards for the diagnosis of chronic pancreatitis and for the evaluation of treatment. Int J Pancreatol 1993;14:205–212.
Howard TJ, Selzer DJ. Operative management of chronic pancreatitis. Techniques Gastrointest Endo 1999;1:186–191.
DiMagno EP. Toward understanding (and management) of painful chronic pancreatitis. Gastroenterology 1999;116:1252–1257.
Dumonceau J-M, Deviere J, Le Moine O, et al. Endoscopic pancreatic drainage in chronic pancreatitis associated with ductal stones: Long-term results. Gastrointest Endosc 1996;43:547–555.
Buscher HCJL, Jansen JBMJ, van DongenR, et al. Longterm results of bilateral thoracoscopic splanchnicectomy in patients with chronic pancreatitis. Br J Surg 2002;89:158–162.
Selzer DJ, Howard TJ, Kesler KA. Management of chylothorax after thoracoscopic splanchnicectomy. J Laparoendoscopic Adv Surg Tech 1999;9:273–276.
Ihse I, Zoucas E, Gyllstedt E, et al. Bilateral thoracoscopic splanchnicectomy: Effects on pancreatic pain and function. Ann Surg 1999;230:785–791.
Naidoo N, Partab P, Pather N, et al. Thoracic splanchnic nerves: Implications for splanchnic denervation. J Anat 2001;199:585–590.
Stone HH, Chauvin EJ. Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis. Br J Surg 1990;77:303–305.
Samad TA, Moore KA, Sapirstein A, et al. Interleukin-1beta-mediated induction of Cox-2 in the CNS contributes to inflammatory pain hypersensitivity. Nature 2001;410:471–475.
Zubieta JK, Smith YR, Bueller JA, et al. Regional mu opiod receptor regulation of sensory and affective dimensions of pain. Science 2001;293:311–315.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Howard, T.J., Swofford, J.B., Wagner, D.L. et al. Quality of life after bilateral thoracoscopic splanchnicectomy: Long-term evaluation in patients with chronic pancreatitis. J Gastrointest Surg 6, 845–854 (2002). https://doi.org/10.1016/S1091-255X(02)00123-3
Issue Date:
DOI: https://doi.org/10.1016/S1091-255X(02)00123-3