Mauricio Zuluaga, General and MIS surgeon1, Ivo Siljic, General and MIS surgeon1, Juan Carlos Valencia, General and MIS surgeon2, Uriel Cardona, General and MIS surgeon2. 1IJP Colombia, Hospitla Universitario Del Valle, Universidad Del Valle, 2IJP Colombia, Clinicafarallones, Clinica Desa, Cali Colombia
INTRODUCTION: The celiac plexus is a structure located in the retroperitoneum, at the level of the lumbar vertebra, which is located in the prevertebral region and has sympathetic fibers. Patients with advanced gastrointestinal cancer and associated pain, one of the management strategies is pain control. Neurolysis of the celiac pleural by laparoscopy was first reported in humans in 2006 in patients with advanced pancreatic adenocarcinoma with excellent results. Experience will be shown in the simplification of the technique for the procedure.
METHOD: Neurolysis of the celiac pleura was performed in 89 patients with advanced gastrointestinal cancer, stomach 52%, pancreas 23% liver 14% other 11%, no complications associated with the procedure, pain improvement was achieved in 80% of patients after process. The standardization of the technique by laparoscopy and its simplification, has made this procedure that is replicable and safe.
Description of the technique: patient in French position, technique of 3 trocars, umbilical trocar 10mm and 2 trocars of 5mm paraumbilical, staging laparoscopy is performed and sampling if necessary, is identified in the region of the lowercurvature of the stomach, the celiac trunk and the emergence of the left gastric artery are identified and 20cc of 90% alcohol diluted to the medium in the lateral fatty bearing are instilled through a pericranial 22 under direct vision, verifying the non-arterial instillation of the alcohol. There were no complications related to the procedure.
RESULTS: We report the experience of one group who underwent celiac pleura neurolysis in 89 patients with advanced gastrointestinal cancer, gastric cancer 52%, pancreatic cancer 23%, liver cancer 14% and another 11%. the most frequent pathology report was adenocarcinoma, 80% of the patients were managed at 24 hours with sustained effects, up to 6 months of follow-up. With a significant decrease in pain medication. Only 1 patient required new laparoscopic neurolysis because of difficult-to-manage pain. The operative time of this procedure was 30 minutes. The standardization of the technique, the use of low cost inputs, makes this type of procedure easily replicable with goodresults in pain management in cancerpatients.
CONCLUSIONS: MIS is offered as one of the fundamental tools for the management of palliative procedures in gastrointestinal cancer. Neurolysis of the celiac pleura with standardization of the technique, use of low cost elements, and the surgeon's skills make this procedure an option of management and control of pain in patients with advanced gastrointestinal cancer, is easily replicable, economical and insurance.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 88087
Program Number: P697
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster