The effect of selective sympathetic denervation on pancreatic exocrine secretion

Nilsson, Carina; Zoucas, Evita; Sternby, Berit; Ihse, Ingemar

doi:10.1007/s004330050064

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…These findings are in accordance with our previous studies of experimental selective microsurgical denervation of the rat pancreas, in which we found improvement after surgery in both exocrine 5 and endocrine 27 parameters, supporting the hypothesis that the sympathetic nervous system exerts inhibitory effects on the pancreas. 4,5 Basal hyperinsulinemia without hypoglycemia has been observed in studies of patients with pancreas transplants. The elevation of insulin is attributed to impaired insulin-insulin feedback inhibition mediated by the sympathetic system.…”

Section: Discussionsupporting

confidence: 83%

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Bilateral Thoracoscopic Splanchnicectomy: Effects on Pancreatic Pain and Function

Ihse

Zoucas²,

Gyllstedt³

et al. 1999

Annals of Surgery

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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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Section: Discussionsupporting

confidence: 83%

“…4,5 Splanchnicectomy by retroperitoneal, intraperitoneal, and transhiatal approaches, transthoracic left splanchnicectomy combined with truncal vagotomy, and percutaneous celiac block have been used in the past to treat pancreatic pain.…”

mentioning

confidence: 99%

Bilateral Thoracoscopic Splanchnicectomy: Effects on Pancreatic Pain and Function

Ihse

Zoucas²,

Gyllstedt³

et al. 1999

Annals of Surgery

View full text Add to dashboard Cite

show abstract

“…The extrinsically denervated pancreas is devoid of preganglionic parasympathetic and postganglionic sympathetic and sensory neurons relying on intra-pancreatic (parasympathetic and NOS immunoreactive) ganglia and nerves for its secretory function. We have earlier demonstrated enhanced basal pancreatic exocrine secretion after extrinsic denervation [26]. This was attributed to the absence of inhibitory adrenergic and/or sensory neurotransmission.…”

Section: Discussionmentioning

confidence: 98%