Abstracts Thoracoscopic Splanchnicectomy for Pancreatic Pain* Henry L. Laws, MD Parasympathetic efferent nerve signals travel to the upper gastrointestinal tract via the vagus nerves while sympathetic efferent messages descend through the splanchnic nerves. All pain sensations reach the central nervous system by the splanchnics. Disruption of all the splanchnic fibers should preclude transmission of pain. Splanchnicectomy should stop pain from the upper gastrointestinal tract, including that originating in the pancreas. Division of these nerves offers relief from intractable pain of pancreatic origin from either cancer or pancreatitis. The splanchnic nerves arise from the sixth through the ninth sympathetic ganglia and descend on the lateral aspect of the vertebral bodies to exit the chest just behind the aorta. The lesser nerves stem from ganglia ten and eleven and exit the chest about one centimeter posterior to the greater. The least splanchnic nerves ordinarily cannot be found. More than 100 splanchnic interruptions had been done by open thoracotomy by 1990. Wide application of double lumen tube anesthesia and modern video thoracoscopy have afforded a less invasive approach. We began to perform thoracoscopy splanchnicectomy in 1991 with Dr, Harlan Stone. Operation may be done on only one side or, if warranted, bilaterally. For midline or mainly left-sided pain, the left side is chosen; for predominantly right-sided pain the right is selected. The lateral position is preferred for a unilateral operation, while the patient is placed prone on the table for a bilateral procedure. After completion of the procedure on one side with re-expansion of the lung the other side is done. If a painful, but unresectable carcinoma is found at laparotomy we do alcohol injections of the celiac ganglia. If pain recurs, splanchnicectomy can still be employed. The operation will be effective 85% of the time. In patients with chronic pancreatitis the pain will often recur in a few months requiring a procedure on the contralateral side. Most patients with cancer will not need a second procedure. The operation has proven to be effective in one patient with duodenal carcinoma and in a patient with gastric carcinoma. References 1. Stone HH, Chauvin EJ. Pancreatic denervation for pain relief in chronic alcohol associated pancreatitis. Br J Surg 1990; Mar: 77(3): 303-305. 2. Landolfo KP, Laws HL, Meyers WC. Thoracoscopic Splanchnicectomy, in Pappas, Schwartz and Eubanks, editors, Atlas of Laparoscopic Surgery. Current Medicine, Inc., Philadelphia, 1996, pp.27.2-27.7 3. Ihse I, Zoucas E, Gyllstedt E, Lillo-Gil R, Andren-Sandberg A. Bilateral thoracoscopic splanchnicectomy: effects on pancreatic pain and function. Ann Surg 1999; 230: 785-791. 4. Saenz A, Kuriansky J, Salvador L, et al. Thoracoscopic splanchnicectomy for pain control in patients with unresectable carcinoma of the pancreas. Surgical Endoscopy 2000; 14: 717-720. Abstracts "Dome Down" Laparoscopic Cholecystectomy Glenn L. Sandler, MD Endoscopic Drainage of Pancreatic Pseudocyst Gary C. Vitale, MD Thoracoscopic Splanchnicectomy for Pancreatic Pain Henry L. Laws, MD CT Guided Percutaneous Drainage of Infected Acute Necrotizing Pancreatitis Patrick C. Freeny, MD Management of Metastatic Carcinoma T. S. Ravikumar, MD Management of Liver Trauma Juan C. Asensio, MD Management of Benign Liver Tumors Leslie H. Blumgart, MD, FRCS Role and Techniques of "Dome-Down" Laparoscopic Cholecystectomy Glenn L. Sandler, MD Thoracoscopic Splanchnicectomy for Pancreatic Pain Henry L. Laws, MD Current ConceptsæAdequate Pain Management Young K. Choi, MD Prevention and Management of Infection Complicating Acute Pancreatitis Henry L. Laws, MD Indication for and Timing of ERCP in Biliary Pancreatitis John Baillie, MB, ChB, FRCP Timing of Laparoscopic Cholecystectomy After Biliary Pancreatitis Gary C. Vitale Magnetic Resonance Angiography Martin R. Prince, MD, PhD Pancreatic Imaging Patrick C. Freeny, MD Endoscopic Ultrasonography Charles Noyer, MD Limited Gastric Resection Jo Buyske, MD Current ConceptsæManagement of Pancreatic Carcinoma Henry A. Pitt, MD Watchful Waiting in the Management of Inguinal Hernia Robert J. Fitzgibbons, MD Treatment of Incisional (Ventral) Hernias: Open Repair Maximo Deysine, MD, FACP Treatment of Incisional (Ventral) Hernias: Laparoscopic Repair Adrian E. Park, MD Indications for Converting to Open Operation John G. Hunter, MD Medicolegal Implications of Common Bile Duct Injury During Laparoscopic Cholecystectomy Kenneth A. Kern, MD, FACS Role and Technique of Pylorus Preserving Pacreatectomy Henry A. Pitt, MD