Effective renal blood flow, glomerular filtration rate and tubular excretory mass in arterial hypertension. II. Effect of supradiaphragmatic splanchnicectomy with lower dorsal sympathetic ganglionectomy: Foà, P. P., Woods, W. W., Peet, M. M., and Foà, N. L.: Arch. Int. Med. 71: 357, 1943

Abstract

Chronic and primary recurrent pancreatitis can be divided into two categories: (1) pancreatitis associated with a lesion or an obstruction of the duct of Wirsung or a perforation of the duct due to necrosis, indicating direct surgical intervention, and (2) primary parenchymal pancreatitis without dilatation of the duct of Wirsung for which pancreatectomy has no place. Numerous arguments have been advanced for the correct operative procedures in the sympathetic system: splanchnicectomy, left celiac ganglionectomy, and postganglion neurectomy. The consistent success of these operations, when their indications are correct, is the best argument for their use.The operation is always carried out in two steps: First, exploratory laparotomy is performed to define the pancreatic lesion and the condition of the duct of Wirsung and biliary tract. Second, sympathetic resection by subperitoneal and subpleural lumbar approach is carried out.The mortality in 215 patients who underwent splanchnicectomy and left celiac ganglionectomy operations was 4.7 percent. In 127 patients followed for 5 years, there were 14 unsatisfactory results including 3 late recurrences, 5 improvements, and 108 definite cures (50 for 20 years, 8 for between 20 and 34 years); that is, there were no relapses of painful attacks, and there was general improvement and weight gain. These results were also observed in alcoholics, but in such patients recovery may be interrupted by the development of hepatic cirrhosis. Splanchnicectomy or left celiac ganglionectomy is not a symptomatic operation for analgesia but rather a curative one, and the cure rate is remarkably stable. This is contrary to the degeneration so frequently observed after pancreatectomy.