Unilateral left-sided thoracoscopic sympathectomy for visceral pain control: a pilot study
Lönroth, H.; Hyltander, A.; Lundell, L.
European Journal of Surgery 163(2): 97-100
1997
ISSN/ISBN: 1102-4151 PMID: 9076435 Document Number: 482081
Objective: To examine the effect of unilateral left sided thoracoscopic denervation of the upper gastrointestinal tract for treatment of chronic pain. Design: Prospective study. Setting: University hospital, Sweden. Subjects: Patients with intractable upper abdominal pain. Nine patients were treated who had the following diagnosis: pancreatic carcinoma (4), duodenal carcinoma (n = 1), chronic pancreatitis (3), and portal vein thrombosis (n = 1). Interventions: Left-sided thoracoscopy with the patient anaesthetised using double-lumen endotracheal intubation that allowed ventilation of the right lung only. The sympathetic chain and splanchnic branches were divided from level IV to X-XI. Main outcome measures: Severity of pain assessed by a visual analogue scale and mean consumption of analgesic drugs. Results: all patients reported substantial relief of pain postoperatively when they were studied during a mean follow-up period of 3 months. However, two patients (l with pancreatic carcinoma and 1 with portal vein thrombosis) had recurrent pain after 3 months. Conclusion: Unilateral thoracoscopic sympathectomy induces adequate and lasting relief of pain caused by benign as well as malignant diseases originating from the pancreatic region.