The effects of splanchnicectomy on the blood pressure in hypertension; a controlled study.

The effect of supradiaphragmatic splanchnicectomy on the blood pressure of 294 hypertensive patients followed for 10 to 18 months after surgery is compared with the effects of nonspecific medical management in a control group of 79 patients similarly studied. The data are presented in simple graphic form. It is concluded that 29 per cent of the hypertensive patients had reductions in blood pressure outside the range of spontaneous variation, that the vascular complications of hypertension decreased the likelihood of a good result, and that extension of the sympathetic ganglionectomy upward appeared to increase the frequency of good results without requiring a two-stage operation or producing significant postoperative orthostatic hypotension. AN ACCURATE evaluation of the effects of various forms of sympathectomy on the blood pressure in essential hyper-tension has been complicated in the past by such deficiencies as lack of suitable control studies, variations in number and type of patients selected for surgery, duration of the follow-up observation period, and the methods of obtaining and reporting the changes in blood pressure. The present report of 338 patients studied before and one year after splanchnicec-tomy and compared with a control group of patients is an attempt at an objective presentation of the effects on the blood pressure to be expected from the procedure of supradiaphrag-matic splanchnicectomy and lower dorsal sympathectomy.' The data will be presented in a graphic form which lends itself to comparative analysis with the results obtained by more extensive sympathectomies, and finally, our experience concerning the prediction of good and poor results on the basis of preopera-tive and early postoperative observations will be summarized. 173 METHODS Three hundred thirty-eight hypertensive patients underwent splanchnicectomy and 79 similar hyper-tensives were examined but not operated upon during the time interval January 1, 1947, to June 1, 1948. Information concerning the status of these individuals 10 to 18 months later was obtained by return visit or by replies to questionnaires sent to their physician. No patient over the age of 55 was included in the study, nor, with few exceptions, was any patient accepted whose nonprotein nitrogen exceeded 45 mg. per 100 cc. or whose hypertension was secondary to renal disease or complicated by a recent cerebrovascular accident, myocardial infare-tion, or congestive heart failure. Seven patients who apparently were on strict low sodium diets at the time of the return visit were excluded from the series, but minor degrees of salt restriction and …