Bilateral thoracoscopic splanchnicectomy for pain in patients with chronic pancreatitis impairs adrenomedullary but not noradrenergic sympathetic function

• Published in: Surgical endoscopy Vol. 26; no. 8; pp. 2183 - 2188
• Main Authors: Buscher, H. C. J. L., Lenders, J. W. M., Wilder-Smith, O. H. G., Sweep, C. G. J., van Goor, H.
• Format: Journal Article
• Language: English
• Published: New York Springer-Verlag 01.08.2012; Springer; Springer Nature B.V
• Subjects: Abdominal Surgery; Adrenal glands; Adrenal Medulla - physiology; Adult; Aged; Autonomic Nerve Block - methods; Autonomic Nervous System - physiology; Biological and medical sciences; Blood pressure; Blood Pressure - physiology; Bronchoscopy; Denervation; Endoscopy; Epinephrine - metabolism; Female; Gastroenterology; Gastroenterology. Liver. Pancreas. Abdomen; General aspects; Gynecology; Heart rate; Hemodynamics - physiology; Hepatology; Humans; Investigative techniques, diagnostic techniques (general aspects); Liver. Biliary tract. Portal circulation. Exocrine pancreas; Male; Medical sciences; Medicine; Medicine & Public Health; Middle Aged; Mortality; Norepinephrine - metabolism; Orthostatic hypotension; Other diseases. Semiology; Pain; Pain, Intractable - blood; Pain, Intractable - etiology; Pain, Intractable - surgery; Pancreas; Pancreatitis; Pancreatitis, Chronic - blood; Pancreatitis, Chronic - complications; Pancreatitis, Chronic - physiopathology; Patients; Posture; Proctology; Respiration; Splanchnic Nerves - surgery; Surgery; Thoracoscopy - methods; Valsalva Maneuver - physiology; Netherlands; Sympathetic activity; Chronic pancreatitis; Thoracoscopy; Splanchnicectomy; Human; Endoscopic surgery; Pancreatitis; Medicine; Chronic; Pain; Treatment; Digestive diseases; Endoscopy; Pancreatic disease
• ISSN: 0930-2794; 1432-2218
• DOI: 10.1007/s00464-012-2152-4

Background Bilateral thoracoscopic splanchnicectomy (BTS) is a well-known technique to alleviate intractable pain in patients with chronic pancreatitis. BTS not only disrupts afferent fibers from the pancreas that mediate pain but also postganglionic sympathetic fibers, which originate in segments T5–T12 and which innervate the vasculature of the liver, pancreas, and the adrenal gland. The purpose of this study was to assess whether and how BTS affects sympathetic noradrenergic and adrenomedullary function in patients with chronic pancreatitis. Methods Sixteen patients with chronic pancreatitis for at least 1 year underwent autonomic function testing before and 6 weeks after BTS for intractable pain. Testing was performed during supine rest and during sympathetic stimulation when standing. Results Supine and standing systolic and diastolic blood pressure were significantly lower post-BTS compared with pre-BTS ( P  = 0.001). One patient showed orthostatic hypotension after BTS. Baseline plasma norepinephrine levels and plasma norepinephrine responses to sympathetic activation during standing were not reduced by BTS. In contrast, supine plasma epinephrine levels and responses during standing were significantly reduced ( P  < 0.001). Parasympathetic activity was unaffected by BTS as shown by unaltered Valsalva ratio, I-E difference, and ΔHRmax. Conclusions BTS for pain relief in patients with chronic pancreatitis reduced adrenomedullary function, due to disruption of the efferent sympathetic fibers to the adrenal gland. BTS did not affect noradrenergic sympathetic activity, although blood pressure was lower after the sympathectomy.