Abstract
Splanchnic neurectomy is of value in the management of chronic abdominal pain. It is postulated that the
inconsistent results of splanchnicectomies may be due to anatomical variations in the pattern of splanchnic
nerves. The advent of minimally invasive and video-assisted surgery has rekindled interest in the frequency
of variations of the splanchnic nerves. The aims of this study were to investigate the incidence, origin and
pattern of the splanchnic nerves in order to establish a predictable pattern of splanchnic neural anatomy
that may be of surgical relevance. Six adult and 14 fetal cadavers were dissected (n¯38). The origin of the
splanchnic nerve was bilaterally asymmetrical in all cases. The greater splanchnic nerve (GSN) was always
present, whereas the lesser splanchnic nerve (LSN) and least splanchnic nerve (lSN) were inconsistent (LSN,
35 of 38 sides (92%); LSN, 21 of 38 sides (55%). The splanchnic nerves were observed most frequently
over the following ranges: GSN, T6±9: 28 of 38 sides (73%); LSN, when present, T10±11: (10 of 35 sides
(29%); and lSN, T11±12: 3 of 21 sides (14%). The number of ganglionic roots of the GSN varied
between 3 and 10 (widest T4±11; narrowest, T5±7). Intermediate splanchnic ganglia, when present, were
observed only on the GSN main trunk with an incidence of 6 of 10 sides (60%) in the adult and 11 of 28
sides (39%) in the fetus. The higher incidence of the origin of GSN above T5 has clinical implications,
given the widely discussed technique of undertaking splanchnicectomy from the T5 ganglion distally. This
approach overlooks important nerve contributions and thereby may compromise clinical outcome. In the
light of these variations, a reappraisal of current surgical techniques used in thoracoscopic splanchnicectomy
is warranted.