Organs

1
Saha Sympathectomy and nerve blocks
Pancreatic pain pathway
Organs Celiac ganglia Splanchnic nerves
Thoracic sympathetic chain Cell body in
spinal cord Higher centers Visceral pain
carried by sympathetic afferents
2
Splanchnicectomy

• (earlier transhiatal approach at laparotomy)
• Indications
• Non dilated Pancreatic duct
• Diffuse disease
• Failure of other modalities
• Unilateral vs. Bilateral?
• Fibers intermingle in celiac ganglia
• Lt sided- epigastric for Lt sided pain
• If pain recurs then repeat other side
• No loss of pancreatic function

3
Saha Sympathectomy and nerve blocks
Thoracic splanchnicectomy
Simple, minimally invasive safe Complications
Hemorrhage Chylothorax Significantly reduced
pain in 46 at 2yrs (Br J Surg. 2002
Feb89(2)158-62) Average pain score reduced by
50 (Ann Surg. 1999 Dec230(6)785-90)
4
Saha Sympathectomy and nerve blocks
Nerve blocks

• Celiac plexus Level of T12 and L1, anterior to
  crura and aorta
• Neurolytic agents 50 alcohol 10 phenol
• Percutaneous route Retrocrural/ Transcrural/
  Transaortic/ Anterior
• Methods Fluoroscopic guided/ CT guided/
  Endoscopic US guided
• Complications Orthostatic hypotension/ Diarrhea/
  Paraplegia/ Hemorrhage/ Sepsis
• Results Short term results excellent Better
  results with endoscopic US

5
Saha Sympathectomy and nerve blocks
Conclusions
Thoracoscopic splanchnicectomy is a viable and
available option in the management of patients
with intractable pain for long term pain relief
More studies are needed to evaluate long term
effects