Clinical evaluation of transhiatal bilateral splanchnicotomy for patients with intractable supramesenteric pain

Although a transhiatal bilateral splanchnicotomy (TBS) has many advantages, it has not been widely employed as an effective minimal invasive therapy for intractable supramesenteric pain. Furthermore, the effects of TBS have not yet been clearly evaluated. Between 1995 and 1997, TBS was performed on 11 patients with intractable epigastric and/or flank pain due to unresectable pancreatic cancer, chronic pancreatitis, or an unknown cause. The effect of TBS on the pain was evaluated using a novel simple pain score and pain reduction percentage scaled on the basis of the medication and the judgments by patients themselves, respectively. The detection and cutting of the bilateral great splanchnic nerves were easily performed in all of the patients using common flexible chondrocostal retractors. The evaluation of the TBS effect using the pain score clearly demonstrated the early and late mean postoperative pain score (1.1 +/- 0.9 and 1.4 +/- 1.2: mean +/- SD) to be significantly (P = 0.0002 and P = 0.002, respectively) lower than the preoperative pain score (3.5 +/- 0.7). Furthermore, the mean postoperative pain reduction percentage (85% +/- 13%) evaluated by those patients was also significantly different (P < 0.0001). The present study showed no significant complications for TBS, except for minor complications such as the transient fall of blood pressure and reparable pleural damage. Interestingly, a long-term follow-up revealed that no complications related to the splanchnicotomy were observed. These results indicate that TBS is a useful treatment for patients with intractable supramesenteric pain caused by cancer as well as benign diseases.