Thoracoscopic Thoracic Splanchnicectomy for Pain Control in Chronic Pancreatitis

Kusano, Toshiomi; Miyazato, Hiroshi; Isa, Tsutomu; Shiraishi, Masayuki; Yamada, Mamoru; Matsumoto, Mitsuyuki; Muto, Yoshihiro; Ito, Toshiva

doi:10.3919/ringe1963.57.1072

Cited by 9 publications

(22 citation statements)

References 9 publications

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“…Five publications reported the results of unilateral TS [5,7,10,13,15], and eight publications reported the results of bilateral TS [2,3,8,9,11,12,14,16]. The remainder described the results of unilateral and bilateral procedures [1,4,6]. No comparative studies of TS versus medical therapy or celiac plexus block were found.…”

Section: Resultsmentioning

confidence: 91%

“…A total of 39 patients (12.9%) required further intervention for pain relief after TS [1,2,4,6,7,10,12]. Of the 111 patients who underwent unilateral TS, 15 (13.5%) required previously unplanned contralateral TS after their primary unilateral intervention [1,4,6,7,10].…”

Section: Resultsmentioning

confidence: 97%

“…This review identified 16 reports between 1994 and 2006 that described the results of TS for patients with CP [1][2][3][4][5][6][7][8][9][10][11][12][13][14][15][16]. Five publications reported the results of unilateral TS [5,7,10,13,15], and eight publications reported the results of bilateral TS [2,3,8,9,11,12,14,16].…”

Section: Resultsmentioning

confidence: 98%

“…Of the 111 patients who underwent unilateral TS, 15 (13.5%) required previously unplanned contralateral TS after their primary unilateral intervention [1,4,6,7,10].…”

Section: Resultsmentioning

confidence: 99%

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Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis

et al. 2007

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Section: Resultsmentioning

confidence: 91%

Section: Resultsmentioning

confidence: 97%

Section: Resultsmentioning

confidence: 98%

“…Of the 111 patients who underwent unilateral TS, 15 (13.5%) required previously unplanned contralateral TS after their primary unilateral intervention [1,4,6,7,10].…”

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis

et al. 2007

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“…This is not harmful but helps the patients in terminal stage by the relief of constipation symptom. More aggressive splanchnicectomy was introduced by Kusano et al (1997) and Le Pimpec Barthes et al (1998). Their technique involves the transection of the sympathetic trunks and may sacrifice the somatic sympathetic nerves.…”

Section: Discussionmentioning

confidence: 99%

Anatomy of thoracic splanchnic nerves for surgical resection

et al. 2008

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Thoracic splanchnic nerves conduct pain sensation from the abdominal organs around the celiac ganglion. Splanchnicectomy is the procedure used mainly for the control of intractable visceral pain. Forty-six human posterior thoracic walls were dissected. The formation pattern, course, and incidence of communication of the thoracic splanchnic nerves were investigated. The greater splanchnic nerves (GSNs) were formed by nerve branches from the T4-T11 thoracic sympathetic ganglia and the most common type was formed by T5-T9 (21.7%). The uppermost branches originated from T4-T9 while the lowermost branches emanated from the T7-T11. Two to seven ganglia contributed to the GSNs. In 54.3% of the specimens, at least one ganglion in the GSN-tributary ganglionic array did not branch to the GSN. The lesser splanchnic nerves (LSNs) were formed by the nerve branches of the T8-T12 thoracic sympathetic ganglia and the most common type was formed by T10 and T11 (32.6%). One to five ganglia were involved in the LSNs. The least splanchnic nerves (lSNs) were composed of branches from the T10-L1 thoracic sympathetic ganglia and the most common type was composed of nerve branches from T11 and T12 or from T12 only (each 30.4%). One to three ganglia were involved in the lSNs. In 54.3% of the specimens, interconnection between the GSNs and the LSNs existed, bringing the possible bypass around the transection of the GSNs. The splanchnic nerves that appear in textbooks occurred in a minority of our specimens. We provided expanded anatomical data for splanchnicectomy in this report.

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A review of the thoracic splanchnic nerves and celiac ganglia

et al. 2010

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Anatomical variation of the thoracic splanchnic nerves is as diverse as any structure in the body. Thoracic splanchnic nerves are derived from medial branches of the lower seven thoracic sympathetic ganglia, with the greater splanchnic nerve comprising the more cranial contributions, the lesser the middle branches, and the least splanchnic nerve usually T11 and/or T12. Much of the early anatomical research of the thoracic splanchnic nerves revolved around elucidating the nerve root level contributing to each of these nerves. The celiac plexus is a major interchange for autonomic fibers, receiving many of the thoracic splanchnic nerve fibers as they course toward the organs of the abdomen. The location of the celiac ganglia are usually described in relation to surrounding structures, and also show variation in size and general morphology. Clinically, the thoracic splanchnic nerves and celiac ganglia play a major role in pain management for upper abdominal disorders, particularly chronic pancreatitis and pancreatic cancer. Splanchnicectomy has been a treatment option since Mallet-Guy became a major proponent of the procedure in the 1940s. Splanchnic nerve dissection and thermocoagulation are two common derivatives of splanchnicectomy that are commonly used today. Celiac plexus block is also a treatment option to compliment splanchnicectomy in pain management. Endoscopic ultrasonography (EUS)-guided celiac injection and percutaneous methods of celiac plexus block have been heavily studied and are two important methods used today. For both splanchnicectomies and celiac plexus block, the innovation of ultrasonographic imaging technology has improved efficacy and accuracy of these procedures and continues to make pain management for these diseases more successful.

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Thoracoscopic Thoracic Splanchnicectomy for Pain Control in Chronic Pancreatitis

Cited by 9 publications

References 9 publications

Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis

Systematic review of the role of thoracoscopic splanchnicectomy in palliating the pain of patients with chronic pancreatitis

Anatomy of thoracic splanchnic nerves for surgical resection

A review of the thoracic splanchnic nerves and celiac ganglia

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