An Objective Study of Pain Relief in Chronic Pancreatitis from Bilateral Thoracoscopic Splanchnicectomy. Discussion

Pain from chronic pancreatitis leads to disability, malnutrition, and narcotic dependence. This study demonstrates the efficacy of bilateral thoracoscopic splanchnicectomy in reducing pain associated with chronic pancreatitis. This study reviews results from this procedure between 1998 and 2006. Data included pain levels, hospital admissions, nutritional status, and the duration between splanchnicectomy and pancreatic resection. Narcotic use was determined from the Kentucky All Schedule Prescription Electronic Reporting system. Fifty-four patients underwent splanchnicectomy with technical success in 98 per cent and immediate symptom relief in 43 per cent. Additional surgery occurred in 44 per cent (average time to surgery was 26 months). Failure of pain relief occurred in 17 per cent, early recurrence (6-12 months) occurred in 15 per cent, and 68 per cent had over a year of relief. Admissions decreased from 5.8 to 2.9 post surgery. Average pain levels decreased from 8.7 to 6.1 post surgery (P < 0.001). Kentucky All Schedule Prescription Electronic Reporting demonstrated decreased or stable narcotic use in half of the patients. Over half (55%) maintained or gained weight, whereas 39 per cent experienced weight loss. Discharge occurred 24-hours after surgery. Bilateral thoracoscopic splanchnicectomy demonstrates a positive impact on pain control, hospital admissions, nutritional status, and narcotic use. Thoracoscopic splanchnicectomy is an effective and safe option in the treatment of pain from chronic pancreatitis.