[Bilateral posterior thoracoscopic splanchnicectomy in a face-down position in the management of chronic pancreatic pain].

Unlabelled: Abdominal pain is the primary symptom in most patients with chronic pancreatic diseases. Many authors have reported that thoracoscopic splanchnicectomy is a effective and recognize method for relief of chronic pain due to pancreatic cancer and chronic pancreatitis. Time ago only few authors used bilateral toracoscopic splanchnicectomy in one session because they observed side effects as transient orthostatic hypotension and/or diarrhea. The aim of this study was retrospective analysis of two methods of the bilateral thoracoscopy splanchnicectomy at one session. We comparsion operation's time, intraoperative and postoperative complication, hospitalization and evaluate pain intensity in patients with intractable pain due to advanced pancreatic cancer and chronic pancreatitis.

Material And Methods: The study group comprised 94 patients, aged 26-69 years operated with bilateral thoracosopic splanchnicectomy at one session approach between years 1997-2006. There were two groups. First (I group) for operated patients in thoracotomy position with changed the position of patients at the same procedure and second (II group) for posterior thoracoscopic approach with the patient in a face-down position. In all patients evaluated operation's time, intraoperative and postoperative complication and pain intensity before and for 6 months after the thoracoscopic splanchnicectomy.

Results: The mean operating time in the I group was 58.3 min. and the II group was 43.5 min. (p < 0.05). There were no intraoperative and postoperative complications, only 16 patients I group and 3 patients II group had intercostal neuralgia after operation. The mean hospitalization's time in all patients were 1.3 day. In all patients pain was reduced significantly after the operation and during postoperative follow-up.

Conclusion: Posterior thoracoscopic splanchnicectomy approach with the patient in a face-down position is a save, minimally invasive and reduce operation time procedure.