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

Tuesday, July 2, 2013

In  our  own  clinic  we  stopped  performing   sympathectomies  in  1994,  since  we  were alarmed  by  the  complication  and  failure  rate

Physical  medicine
Russell,  Alan  L.  Patient  Care 13.2  (Feb  2002):  19. 

Seven cases of enlargement  of  the  Breast - A  New  Side  Effect  of  Sympathectomy for hyperhydrosis

The  phenomenon  of  hyperhidrosis  is  a  pathological  state  caused  by  unknown  stimulus  of  the  sympathetic  nervous  system.  When  a  variety  of  conservative  treatments have  failed,  surgery  which  involves  the  removal  of  some  ganglia  of  the  cervical  sympathetic  chain,  is  the  treatment  of  choice.  In  the  last  four  years  we  operated  on 253  patients  for  palmar  hyperhidrosis  using  the  transaxillary  approach  only. Recently,  a  new  side  effect  of  surgery  has  come  to  our  attention.  This  phenomenon  is enlargement  of  the  breast  on  the  operated  side.  Our  series  show  seven  cases  (2.4%)  of  women  operated  for  palmar  hyperhidrosis  who  manifested  this phenomenon,  two  of  them  bilaterally.  The  enlargement  of  the  breast  was  found  usually  by  the  second  follow-­up  visit  after  operation  when,  in  most  cases,  the  patient mentioned  it.Examination  of  the  breast  revealed  enlargement  of  a  few  centimeters  which  in  several  patients  required  a  change  to  a  larger  brassiere  size.  In  both  of our  patients  who  underwent  bilateral  surgery,  the  breasts  enlarged  until  they  were  equal  in  size.  The  women  then  did  not  complain  further.  

Enlargement  of  the  Breast-­-­A  New  Side  Effect  of  Transaxillary  Cervical  Sympathectomy:  Case  Report Kott,  Itamar;;  Hauptman,  Eli;;  Zelkovsky,  Avigdor;;  Reiss,  Raphael.  Vascular  and  Endovascular  Surgery 20.1  (Jan  1986):  50-­54. 

Monday, July 1, 2013

Parry-Romberg syndrome and thoracoscopic sympathectomy

 2004 May;73(5):343-4, 346.

Parry-Romberg syndrome and sympathectomy--a coincidence?


Department of Dermatology, Chaim Sheba Medical Center, Sackler School of Medicine, Tel Aviv University, Israel.


Parry-Romberg syndrome is a clinical entity consisting of progressive hemifacial atrophy appearing at a young age. Animal studies indicate that sympathectomy can produce hemifacial atrophy. To our knowledge, this is the first report of a patient with a possible association between Parry-Romberg syndrome and thoracoscopic sympathectomy.

ML Moss, GF Crikelair. Progressive facial hemiatrophy following cervical sympathectomy in the rat. Arch Oral Biol 1960;1:254-810.1016-03-9969(60)90052-214424619

Case of progressive facial hemiatrophy with cervical sympathetic hyperactivity as underlying aetiology

P Ségura, C Speeg-Schatz, JM Wagner, O Kern. Claude Bernard-Horner syndrome and its opposite, Pourfour du Petit syndrome, in anesthesia and intensive care [in French]. Ann Fr Anesth Reanim 1998;17:709-2410.1016/S0750-7658(98)80108-1975...9

sympathectomy a 'systemic' procedure and in some cases can have 'unpredictable side-effects'

'Systemic' surgery divides the sympathetic chain either in the chest or in the lumbar area. Endoscopic thoracicsympathectomy (ETS) works extremely well for palmar sweating. Long-term studies show it is durable and the majority of patients are satisfied. Most cases will get a degree of compensatory sweating elsewhere on the body that is tolerable, but in some cases ETS can have unpredictable side-effects.


AnonymousPulse (Apr 6, 2011): 18.
Surgeon Mr Alan Cameron answers GP Dr Pam Brown's questions
Mr Alan Cameron is a consultant surgeon in Ipswich and past-president of the International Society for Sympathetic Surgery
Dr Pam Brown is a GP in Swansea

Sunday, June 30, 2013

Several  reports  have  dealt  with  the  alteration  of  antibody  responses  of  spleen  and  lymph nodes  following  sympathectomy

Sympathectomy significantly alters vascular responses

Vascular responses to warming were studied in hemiplegic patients and after sympathectomy, using venous occlusion plethysmography of foot and leg. Comparisons were made with corresponding age groups. The pattern of response was essentially unchanged in hemiplegic patients, but was altered substantially where sympathetic pathways had been interrupted.

Vasomotor Responses in the Extremities of Subjects with Various Neurologic Lesions

I. Reflex Responses to Warming

Sympathectomy involves division of adrenergic, cholinergic and sensory fibers which elaborate adrenergic substances during the process of regulating visceral function