Fomenko A.V., Kartashov A.M., Malyugin E.E. Krasnogorsk, Moscow Region. Thoracoscopic splanchnic sympathectomy (TSSE) was performed in 5 patients suffering from painful chronic pancreatitis in a hospital between 1999 and 2000. The primary indication for surgery was severe pain, which was relieved only by narcotic analgesics. Radical surgery was impossible due to the tumor conglomerate spreading to surrounding tissues. Right-sided TSSE was performed in all patients with pancreatic head tumors and one patient with chronic pancreatitis, while left-sided TSSE was performed in three patients with painful chronic pancreatitis. Due to the development of mechanical jaundice, patients with pancreatic tumors had previously undergone reconstructive surgeries on the biliary system (cholecystostomy in 2 patients; external choledochostomy in 1 patient; cholecystectomy and hepaticocholedochoejejunostomy with a Roux-en-Y loop in 2 patients). Patients in this group were admitted to the hospital on an emergency basis due to severe pain. Patients in the second group (with a painful form of chronic pancreatitis) had been repeatedly treated in gastroenterology departments for a long time. In order to determine the side where TSSE should be performed, as well as the possible effectiveness of the upcoming surgery, in addition to morphological and anatomical signs of the disease, the patient underwent a sacrospinal block with a local anesthetic (0.5% lidocaine - 100.0 ml) in the 9-10 intercostal spaces. The surgical side was determined after assessing the effectiveness of the sacrospinal block. Bilateral block was not used because pain was typically completely relieved "at the end of the needle." Based on this differential test, right-sided TSSE was performed in 6 patients, and left-sided TSSE was performed in 3 patients. The surgery was performed with the patient lying on the side opposite the surgical side. Endotracheal anesthesia with separate bronchial intubation using a double-lumen tube was a key requirement for adequate anesthesia. The surgery was performed by a team of two surgeons. A lung retractor, thoracoscope, and coagulation hook were used. The dome of the diaphragm, aorta, hemiazygos vein, and costoclavicular joint were identified intraoperatively. After identifying the sympathetic trunk and its major branches, the parietal pleura was dissected, and selective splanchnic sympathectomy of the greater and lesser celiac trunks was performed. The surgery concluded with hemostasis monitoring and drainage of the pleural cavity with a silicone drain with active aspiration. The drains were removed after 24 hours following a control X-ray. One intraoperative complication occurred: bleeding from a branch of an intercostal artery, which was stopped with electrocoagulation. Early postoperative complications were observed in 3 patients undergoing surgery for painful chronic pancreatitis: pulmonary embolism of small branches on the side of the surgery, intercostal neuralgia, and acute pancreatitis without pain. There were no surgical-related deaths. The postoperative period lasted 6.5 days. Good results were achieved in five patients undergoing surgery, including pain relief, discontinuation of narcotic and non-narcotic analgesics, and improved lifestyle habits in all patients with pancreatic tumors. Satisfactory results were achieved in two patients with painful chronic pancreatitis. Unsatisfactory results were observed in two patients, despite effective postoperative sacrospinal block. Thus, our experience has shown that TSSE is highly effective in patients with pancreatic head tumors and less so in patients with painful chronic pancreatitis. Sacrospinal block has diagnostic value in determining surgical indications, selecting the surgical side, and potentially assessing the effectiveness of thoracoscopic splanchnic sympathectomy.