Long-term follow-up of thoracoscopic splanchnicectomy for chronic pancreatitis pain

Abstract

Thoracoscopic SPL offers short-term relief of pain from chronic pancreatitis, but the relief is not durable in most cases. Similarly, there are short-term improvements in degree of disability, mood, and freedom from narcotic use that are not sustained in the long-term. Nevertheless, two-thirds of patients stated that they would have the surgery again.

Opioid use determines success of videothoracoscopic splanchnicectomy in chronic pancreatic pain patients

“…These results are coherent with other authors [1][2][3][6][7][8][9]. However, it was noticed that, not equally in all patients, the pain reduction could be achieved.…”

“…It is a method not requiring especially long training for both monolateral and simultaneous bilateral procedure [4,5]. Despite promising results at the initial phase after the introduction of this method, the late quality-of-life results and satisfaction from the surgery are not definite [6][7][8]. Howard et al [9] suggested that the recurrence of pain ailments after VSPL can be due to nerve fiber architecture rearrangements and secondary neuropathic pain after upper abdomen surgeries.…”

Anatomy of thoracic splanchnic nerves for surgical resection

“…As a result, surgical trials based on such scant information often lead to uneven degrees of symptom relief. Success rates for pain management following splanchnicectomy vary from 60 to 90% between different surgeons (Pietrabissa et al, 2000;Leksowski, 2001;Maher et al, 2001;Makarewicz et al, 2003). These results are not due to the differing level of skill among surgeons but to the lack of established surgical protocol based on well-defined anatomical information.…”

Surgery for Chronic Pancreatitis

“…One-third to half of these patients have shown good reduction of pain in a short-term follow-up; however, only 10% of them seem to show a benefit at 24 weeks [64]. Many studies [64][65][66] show that the early good results achieved by neuroablative procedure decline with time elapsed as compared with the durable relief obtained from conventional surgical procedures. Over twothirds of patients would ultimately need surgery again [66].…”

“…Many studies [64][65][66] show that the early good results achieved by neuroablative procedure decline with time elapsed as compared with the durable relief obtained from conventional surgical procedures. Over twothirds of patients would ultimately need surgery again [66]. Patients who are at a high risk for surgery or deny it and who those have failed to respond to surgical management can be offered neuroablative procedure, although larger data are needed to support its routine role.…”