Unilateral left-sided thoracoscopic sympathectomy for visceral pain control: a pilot study.

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 (1 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.