Thoracoscopic Splanchnicectomy for Pain Control in Irresectable Pancreatic Cancer

Katri, Khaled; Ramadan, Bassem; Mohamed, Fathalla S.

doi:10.1089/lap.2007.0066

Cited by 11 publications

(6 citation statements)

References 15 publications

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“…Another study documented similar declining success rates of 90% at 6 months and 49% beyond 15 months [13]. The efficacy in relief of pain in pancreatic cancer by thoracoscopic splanchnicectomy is supported by three studies [8,10,12] and disputed in one [5]. Overall it appears to be an effective technique with varying success rates.…”

Section: Discussionmentioning

confidence: 88%

“…Although bilateral splanchnicectomy was noted to provide an acceptable method of pain relief, this option did not gain popularity as it carries the burden of a thoracotomy which could result in high morbidity. Thoracoscopy provides an alternative technique with reduced morbidity [3,5,[8][9][10][11][12][13][14].…”

Section: Discussionmentioning

confidence: 99%

“…This could be performed by open surgery which requires bilateral thoracotomy where the morbidity could be substantially high. A smart option would be thoracoscopic ablation of the splanchnic nerves [3,5,[8][9][10][11][12][13]. Thoracoscopy provides a clear visualization of the splanchnic nerve branches with a magnified view [8].…”

Section: Introductionmentioning

confidence: 99%

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Thoracoscopic splanchnicectomy for the relief of chronic pancreatic pain

Galketiya¹,

Pinto

2016

Sri Lanka j Surg

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Chronic pancreatitis may cause disabling pain unresponsive to oral analgesics and/or drainage procedures. Radiological guided coeliac plexus ablation is beneficial, although it is only a temporary method for pain relief. Bilateral splanchnicectomy provides a more permanent pain relief method with minimum morbidity if performed by thoracoscopy. The results of twenty one thoracoscopic splanchnicectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2015 were analysed to evaluate the surgical technique and to quantify the efficacy of pain relief. All had an acceptable operating time, no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average pain score of 8-10 pre-operatively. This was reduced to 1 or no pain on post-operative day one in all patients. Eighteen patients out of 21 (86%) remained pain free during follow up; follow up ranged from one month to forty eight months. Bilateral thoracoscopic splanchnicectomy is safe and provides effective relief of chronic agonizing pancreatic pain.

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Section: Discussionmentioning

confidence: 88%

Section: Discussionmentioning

confidence: 99%

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Thoracoscopic splanchnicectomy for the relief of chronic pancreatic pain

Galketiya¹,

Pinto

2016

Sri Lanka j Surg

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“…10 The same analysis concludes poor outcome in patients treated with opioids for longer periods and recommends early intervention.10 This is supported by another study. 10 The efficacy in relief of pain in pancreatic cancer by thoracoscopic splanchnicectomy is supported by three studies 7,12,15 and disputed in one. 11 Overall it appears to be an effective technique with varying degrees of success rates and better used prior to prolong use of opioids.…”

Section: Discussionmentioning

confidence: 99%

Use of Thoracoscopic Splanchnicectomy for the Relief of Chronic Pancreatic Pain: a Case Series

Galketiya¹,

Pinto²,

Bandara

2014

imjm

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Chronic pancreatitis may cause disabling pain not responding to oral analgesics and/or drainage procedures. Although pancreatectomy is a definitive treatment, it carries a significant morbidity and mortality. Celiac plexus ablation is beneficial, although it is a temporary method for pain relief. While bilateral splanchnicectomy provides a more permanent pain relief, it is a difficult procedure requiring thoracotomy and results in significant morbidity. Thoracoscopy is an attractive alternative to perform splanchnicectomy. The results of a case series on video assisted thoracoscopic sympathectomies performed at the university surgical unit, Peradeniya, Sri Lanka from January 2011 to June 2013 was analyzed to evaluate the surgical technique and to quantify the efficacy of pain relief. Operating time, blood loss, intraoperative complications, conversion to open surgery, pre-operative and post-operative pain assessment using visual analogue scale score (VAS) were recorded. Seven patients who underwent video assisted thoracoscopic splachnicectomy were analyzed. All had an acceptable operating time (6omin), no measurable blood loss, no conversions to open surgery, no intercostal drainage, early mobilization and feeding. All had an average VAS of 8-10 pre-operatively. This reduced to a VAS of 1 or no pain in all, on post-operative day one, at one and six months. The few who experienced mild pain needed occasional use of paracetamol or diclofenac sodium. Non required narcotic analgesics. Bilateral thoracoscopic splanchnicectomy is a safe, effective and more attractive alternative as it carries a minimum morbidity, mortality and provides an excellent relief of chronic agonizing pancreatic pain.

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“…However, the evidence and benefits of this over the two established techniques is still fairly limited, and it would appear that pain relief by using this device is at best similar to that of conventional vertebroplasty and kyphoplasty [42]. The advantage of this being that it can be performed bilaterally in the same prone position, higher precision with video-assisted identification and can perform the division of all the roots (T5-T12) of the splanchnic nerves [53]. ].…”

Section: Vertebroplastymentioning

confidence: 99%