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The surgery was performed under general anaesthesia with the patient in the right lateral position. Five ports were used including the camera port. The positions of ports are shown in figure 2. No abnormality was evident in the peritoneal cavity. The stomach was lifted up using an instrument through the epigastric port. The gastrocolic omentum was divided. A pancreatic mass, involving the tail and compressing the splenic hilum was noted. The pancreas was retracted caudally; the splenic artery was dissected on its upper border and divided between clips. The splenocolic attachments were divided. The spleen was mobilised from its attachments to the diaphragm. The pancreas was lifted up and the splenic vein was identified and divided between clips. The pancreas was transected through the body using an ultrasonic dissector. The specimen was placed into a refashioned uribag and retrieved via a 5 cm mini incision

 Laproscopic pancreatico-duodenectomy is a treatment method which leads to reduced perioperative complications and speedy recovery. However there is a steep learning curve to be negotiated before it becomes standard practice.

Chronic pancreatitis may cause disabling pain unresponsive to oral analgesics and/or drainage procedures. Radiological guided coeliac plexus ablation is beneficial, although it is only a temporary method for pain relief. Bilateral splanchnicectomy provides a more permanent pain relief method with minimum morbidity if performed by thoracoscopy. The results of twenty one thoracoscopic splanchnicectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2015 were analysed to evaluate the surgical technique and to quantify the efficacy of pain relief. All had an acceptable operating time, no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average pain score of 8-10 pre-operatively. This was reduced to 1 or no pain on post-operative day one in all patients. Eighteen patients out of 21 (86%) remained pain free during follow up; follow up ranged from one month to forty eight months. Bilateral thoracoscopic splanchnicectomy is safe and provides effective relief of chronic agonizing pancreatic pain.

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