The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.

Spinal cord infarction occurring during thoraco-lumbar sympathectomy
J Neurol Neurosurg Psychiatry 1963;26:418-421 doi:10.1136/jnnp.26.5.418

Saturday, July 9, 2011

"most physicians do not recommend ETS surgery because of the serious negative side effects of the procedure"

blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy

Anaesth Intensive Care. 2003 Oct;31(5):581-3.

Orthodeoxia--an uncommon presentation following bilateral thoracic sympathectomy.


Departments of Intensive Care and Vascular Surgery, Sir Charles Gairdner Hospital, Pharmacology Unit, School of Medicine and Pharmacology, University of Western Australia, Perth, Western Australia.


We present a case of orthodeoxia (postural hypoxaemia) which resulted from a combination of lung collapse/consolidation and blunted hypoxic pulmonary vasoconstriction due to partial interruption of the sympathetic nerve supply to the lung by bilateral thoracic sympathectomy.

Tuesday, July 5, 2011

A depression in the heart rate and decrease in response to stress is expected to some degree in all patients after sympathectomy

A depression in the heart rate with resultant drop in the heart rate product and decrease in response to stress is expected to some degree in all patients. Some series have described this finding in most patients, whereas others report at least a 10% drop in heart rate in all patients. This is a possible major cause for postoperative dysfunction and should be cautiously sought after. Patients with resting heart rate that is below 50 to 60 beats/min should undergo electrocardiography. It is recommended that if the heart rate is low on a subsequent electrocardiogram as well, that a tilt test should be performed to exclude patients in whom there is an inordinately high risk of postoperative bradycardia.

Sunday, July 3, 2011

mechanisms of the post-sympathectomy syndrome and of the action of these drugs are uncertain

Fifty-six consecutive patients who subsequently underwent ninety-six lumbar sympathectomies were studied prospectively with regard to the development of postoperative pain. Pain after operation was observed in thirty-four extremities by twenty-five of the patients (35 per cent). It began abruptly an average of twelve days after operation and was often accentuated nocturnally. The pain was almost always described as a deep, dull ache and persisted two to three weeks before spontaneously remitting. Postsympathectomy pain of such severity that parenteral narcotics afforded no relief developed in two of these fifty-six patients and in nine additional patients. Treatment with carbamazepine produced dramatic reduction in the intensity of pain in seven of these nine patients within twenty-four hours after the institution of therapy. Two patients were given intravenous diphenylhydantoin and both experienced immediate relief of pain. The mechanisms of the syndrome and of the action of these drugs are uncertain.

post-sympathectomy syndrome

Sympathectomy. Some patients with CRPS have good pain relief from sympathetic nerve blocks, but the pain relief does not last long. For these patients, doctors might suggest a sympathectomy (killing the sympathetic nerves leading to the painful body part, either by using surgery or chemicals). Some patients get longer pain relief after the sympathectomy, but others do not. Also, there is the slight chance that patients who get a sympathectomy for CRPS of the leg might develop a new pain syndrome, called post-sympathectomy syndrome.

On the subject of "reversal" of sympathectomy

Reply from Dr Alan Cameron (UK):

I am sorry to be the bearer of bad news, but there was little new on reversals at the recent ISSS. There was only one formal paper, from Connery in New York, who had used the Da Vinci robot for an intercostal nerve graft to somebody who had had T2-4 removed. The reason for using the robot was to suture the graft rather than glue it. It did seem to have worked. There was a bit of discussion about use of an artificial neural tube, but nobody seemed to have used it for ETS-reversal. Reisfeld was there of course, but did not present his reversal results; talking to him he seemed a bit unsure about whether they worked. Equally the Italians are dubious. The Australians were represented by Hensman, but I did not get a chance to quiz him on their progress as he had to leave early.
So no great breakthrough I am sorry to say, in fact rather a retrenchment.
If I hear anything different I shall of course let you know,