Splanchnicectomy for the treatment of intractable abdominal pain

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IN selecting a procedure for the relief of abdominal pain due to disease for which there is no medical or surgical cure, the neurosurgeon frequently overlooks the advantages of splanchnic and sympathetic denervation of the upper abdominal viscera. This report is an evaluation of 39 splanchnicectomies done for intractable abdominal pain in the years 1950 through 1965 at the Cleveland Clinic Hospital (Fig. 1). The results have been evaluated in two groups, procedures performed for: (1) nonneoplastic disease, and (2) neo-plastic disease (Table 1). Nearly half the cases are in each category, 17 for benign, and 22 for neoplastic disease. The surgical technic and the neuro-anatomic and neurophysiologic bases for the procedure are briefly discussed.

Surgical Technic

The procedure is performed according to the method described by Peet1 in 1935. An incision is made at the eleventh rib to expose the extrapleural space and the lower thoracic ganglia and intervening trunk. The greater splanchnic nerve, together with the lesser and least splanchnic nerves, is resected as extensively as possible. This is performed with ease bilaterally in one stage.

With the patient prone, a paramedian incision is centered over the eleventh rib (Fig. 2). The proximal 5 inches of the eleventh rib is resected and the pleura is separated from the lateral margin of the vertebral column, the lower ribs, and the costal articulations. The ganglionated chain is then identified as it runs across the costovertebral articulations (Fig. 3). This chain is excised between silver clips at or in the substance . . .



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