Multivisceral pelvic surgery is possible with acceptable morbidity and QoL. Thorough patient selection and multimodal therapy are necessary to attain maximum benefit.

ObjectiveTo evaluate prospectively the effect of bilateral thoracoscopic splanchnicectomy on pancreatic pain and function. Summary Background DataSevere pain is often the dominant symptom in pancreatic disease, despite a wide variety of methods used for symptom relief. Refinement of thoracoscopic technique has led to the introduction of thoracoscopic splanchnicectomy in the treatment of pancreatic pain. MethodsForty-four patients, 23 with pancreatic cancer and 21 with chronic pancreatitis, were included in the study and underwent bilateral thoracoscopic splanchnicectomy. Effects on pain (visual analogue scale) and pancreatic function (standard secretin test, basal serum glucose, plasma insulin, and Cpeptide) were measured. ResultsFour patients (9%) required thoracotomy because of bleeding. There were no procedure-related deaths. The mean duration of follow-up was 3 months for cancer and 43 months for pancreatitis. Pain relief was evident in the first postoperative week and was sustained during follow-up, the average pain score being reduced by 50%. All patients showed a decrease in consumption of analgesics. Neither endocrine nor exocrine function was adversely affected by the procedure. ConclusionsBilateral thoracoscopic splanchnicectomy is beneficial in the treatment of pancreatic pain and is not associated with deterioration of pancreatic function.Chronic pancreatitis and pancreatic cancer are both associated with severe pain and impaired pancreatic function. Ideal treatment options would have a limited risk of drug addiction and would leave the functional capacity of the gland unaffected. Recent advances in laparoscopic technique also include developments in the field of thoracoscopy. The first report on successful thoracoscopic splanchnicectomy for pancreatic pain was published as recently as 1993.1 The rationale for neurotomy in this symptom is based on the fact that sensory nerves from the pancreas run along the hepatic, splenic, and superior mesenteric arteries to the semilunar ganglion, where they become incorporated in the greater and lesser splanchnic nerves, which arise from the 5th to the 11th thoracic ganglia on both sides of the vertebrae. Afferent sympathetic fibers follow the same route, whereas extrinsic parasympathetic innervation is supplied by the vagus. Thoracoscopic splanchnicectomy has targeted the greater splanchnic nerve. 1It is well established that exocrine pancreatic secretion is under neurohormonal control.2 Neurotransmitters and hormones interact in a complex manner, so it is difficult to differentiate the relative influence of each factor. Truncal vagotomy and the administration of atropine dramatically decrease the pancreatic bicarbonate and enzyme responses to hormonal stimulation and to intraduodenal fat, protein, or acid.3 There are suggestions that the sympathetic nervous system inhibits pancreatic exocrine secretion. 4,5 Splanchnicectomy by retroperitoneal, intraperitoneal, and transhiatal approaches, transthoracic left splanchnicectomy combined with truncal vagotomy, and pe...

The effect of alcohol ingestion on primary hemostasis was investigated in fasting healthy humans. Primary hemostasis was measured with the template bleeding time and platelet aggregation assayed with the turbidometric method. Blood was collected to study coagulation and fibrinolysis. 1 h after ingestion of 2 ml/kg body weight of 40% alcohol the plasma alcohol concentration was 19.3 ± 1.6 mmol/l. At this time there was a significant prolongation of the bleeding time accompanied by an impairment of platelet responsiveness to both collagen and ADP. A prolongation of the bleeding time and impairment of platelet function was also found 2 h after alcohol ingestion. Ingestion of this amount of alcohol did not affect parameters of coagulation or fibrinolysis. The data indicate that primary hemostasis is impaired in man after ingestion of moderate amounts of alcohol. This may explain the favorable effect of moderate alcohol consumption on ischemic heart disease but indicates an increased risk for patients with bleeding.

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SummaryThe effect of ethanol intoxication on hemostasis after liver resection was studied in the rat. Plasma levels of ethanol were within the range of those found in ethanol intoxication in man. Bleeding time and blood loss were significantly increased, whereas hemoglobin and hematocrit values were decreased after resection in intoxicated animals compared to controls. APT-times and platelet counts did not differ significantly between the two groups of rats. ADP- and collagen-induced platelet aggregation was slightly inhibited one hour after ethanol administration in non-operated animals. A decrease in pH, such as observed in intoxicated animals, did not affect hemostasis. Distribution of cardiac output was significantly altered after ethanol intoxication. Renal blood flow was increased by 54%, blood flow in the hepatic artery by 40% and in the portal vein by 47%.