The successful addition of a low anticoagulant, low molecular weight heparin (tafoxiparin) to the treatment protocol in two paediatric cases of the GSS may justify the use of this approach in similar cases.

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...

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A considerable number of patients require reoperation after VATS for pneumothorax. Most reoperations are due to prolonged air leakage or recurrent pneumothorax. The risk for reoperation is increased in younger patients, patients operated for recurrent or secondary pneumothorax, and in cases where pulmonary wedge resection is not performed.

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