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

Friday, August 9, 2013

Endoscopic sympathectomy is not minimally invasive - doing the same operation through a smaller incision is not necessarily less invasive

The term ‘‘minimally invasive surgery’’ was initially applied to coelioscopic procedures such as laparoscopic cholecystectomy and hernia repair, thoracoscopic sympathectomy, and arthroscopy, but has since been abandoned, because doing the same operation through a smaller incision is not necessarily less invasive. The term ‘‘minimally invasive parathyroidectomy’’ does not fully convey the nature of the techniques, and, as previously debated in the wider field of minimal-access surgery, carries connotations of increased safety that are not necessarily supported by the existing data [12].
Surg Clin N Am 84 (2004) 717–734
F. Fausto Palazzo, MS, FRCS(Gen),
Leigh W. Delbridge, MD, FACS*

Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia

Thursday, August 8, 2013

Endoscopic thoracic sympathectomy remains a fairly controversial procedure

Studies by ETS surgeons have claimed an initial satisfaction rate around 85-95% with at least 2%-19% regretting the surgery and up to 51% of the patients complaining about decreased quality of life. However, at least one study shows a satisfaction rate as low as 28.6.
Most patients report various adverse reactions as a result of the surgery. And, whilst the results of endoscopic thoracic sympathectomy might appear moderately successful in treating hyperhidrosis, there is a high risk of complications.
Along with the normal side effects of surgery, such as pain, bleeding and bruising, the most frequent post surgical complication is ‘compensatory hyperhidrosis’ – where excessive sweating in seen another part of the body as a result, most commonly the lower back or upper thighs.
There is also the potential surgical complication of a pneumothorax, where air becomes trapped between the lung and the internal chest wall, making breathing difficult and painful. Whilst this can be a life-threatening condition, if not too large it generally resolves over time with out further surgical intervention.
Other fairly common complications of endoscopic thoracic sympathectomy include:
         Rhinitis - inflammation of the nose and
         Gustatory sweating - sweating on the face and neck after eating food,
Rarer complications of endoscopic thoracic sympathectomy as a result of nerve damage include:
         Damage to the phrentic nerve. – Phrentic nerve damage can lead to long term shortness of breath, repair of the nerve during the surgery is also possible in some cases..
         Horner’s syndrome, - a condition that causes drooping of the eyelids.
Endoscopic thoracic sympathectomy remains a fairly controversial procedure; with advocates claiming high success rates and minimal complications when performed correctly, whilst opponents report huge variation in post operation satisfaction levels and poor consistency in the surgical procedure as a result of anatomical variations in the sympathetic nerve network between patients and personal preferences between doctors.

Wednesday, August 7, 2013

This is how "Australia’s leading source for trustworthy medical information" describes sympathectomy

"Sympathectomy is a procedure that is used to treat neuropathic pain. It interrupts the sympathetic nervous system either temporarily or permanently."

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