Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response

Sympathetic chain ganglia are responsible for delivering information to the rest of the body regarding stress situations and the fight or flight response. These sympathetic ganglia are the structures that are destroyed during a sympathectomy.
http://www.ast.org/publications/Journal%20Archive/2009/9_September_2009/CE.pdf

from: SURGICAL TECHNOLOGY FOR THE SURGICAL TECHNOLOGIST, A POSITIVE CARE APPROACH

Author: Association of Surgical Technologists
Edition: 003
Product Type: Book w/Multimedia (CD, DVD or Electronic)
ISBN 13: 9781418051686
ISBN 10: 1418051683
Copyright: 2008

The so called 'compensatory sweating' is NOT compensatory:

"When patients with intense CH are analyzed, we observe that the amount of released sweat seems to be much greater than was that occurring at the primary hyperhidrosis location, not translating a simple compensation or sweating transference from one site to the other. Therefore, this hyperhidrosis seems to be reflex, mediated neurologically in the sweating regulatory center in the hypothalamus.

In order to avoid this neurologically mediated reflex, the sympathetic afferents to the hypothalamus should be restored, allowing negative feedback to block the efferent projection of the sweating regulatory center on the periphery.(14) Therefore, only the reinnervation of the sectioned sympathetic chain could recover this reflex."
http://www.scielo.br/scielo.php?script=sci_arttext&pid=S1806-37132008001100013&lng=en&nrm=iso&tlng=en

significant adverse effects on cardiopulmonary physiology

Because of technologic advances and improved postoperative recovery, endoscopic surgery has become the technique of choice for many thoracic surgical procedures^6and 25; however, endoscopic visualization of intrathoracic structures requires retraction or collapse of the ipsilateral lung, which can have significant adverse effects on cardiopulmonary physiology. These cardiopulmonary changes can be further affected by the pathophysiologic changes associated with the disease process requiring the surgical procedure.

Because acute changes in cardiopulmonary function can compromise patient safety severely, a clear understanding of the dynamic interaction between the anesthetic–surgical technique and patient physiology is essential. This article discusses the effect of thoracoscopic surgery and the impact of various anesthetic interventions on cardiovascular and pulmonary physiology. In addition, some recommendations for “damage control” are made.
Anesthesiology Clinics of North America
Volume 19, Issue 1, 1 March 2001, Pages 141-152

Postsympathectomy pain of such severity that parenteral narcotics afforded no relief

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.

http://www.sciencedirect.com/science/article/pii/0002961074902384

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased (unpublished observations), suggesting decreased sympathetically mediated exocytosis and compensatory adrenomedullary activation.

Catecholamines 101, David S. Goldstein
Clin Auton Res (2010) 20:331–352

The mechanisms by which sympathectomy leads to increased local bone loss is unknown

In vivo effects of surgical sympathectomy on intra... [Am J Otol. 1996] - PubMed - NCBI: "Am J Otol. 1996 Mar;17(2):343-6.

In vivo effects of surgical sympathectomy on intramembranous bone resorption.
Sherman BE1, Chole RA.
Author information
1Department of Otolaryngology--Head and Neck Surgery, School of Medicine, University of California, Davis, USA.
Abstract
Bone modeling and remodeling are highly regulated processes in the mammalian skeleton. The exact mechanism by which bone can be modeled at a local site with little or no effect at adjacent anatomic sites is unknown. Disruption of the control of modeling within the temporal bone may lead to various bone disease such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media. One possible mechanism for such delicate control may be related to the ubiquitous and rich sympathetic innervation of all periosteal surfaces. Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects."

Because of the anaesthetic implications and possible surgical complications, many surgeons are reluctant to perform transthoracic sympathectomy

Hypoxaemia is of a major concern during thorascopic sympathectomy. However, the pathophysiology of hypoxaemia and consequent decrease in SpO2 differs between the two anaesthetic techniques.

The normal physiological response to massive atelectasis is an increase in pulmonary vascular resistance (hypoxic pulmonary vasoconstriction) with re-routing of blood to well ventilated lung zones and consequent improvement in PaO2. HOWEVER, DURING ENDOBRONCHIAL ANAESTHESIA FOR THORACIC SYMPATHECTOMY THERE IS AN APPARENT FAILURE OF THIS COMPENSATORY MECHANISM. When more then 70% of the lung is atelectatic, compensation by hypoxic pulmonary vasoconstriction appears ineffective.

During carbon dioxide insufflation using endobronchial intubation, Hartrey and colleagues reported a decrease in systolic arterial pressure of >20mm Hg in 21% of patients. Similarly we have reported sudden hypotension and bradycardia after injudicious carbon dioxide insufflation.

Although extremely rare, sudden cardiac arrest has been reported after left T2-3 sympathetic nerve transection. While the exact pathophysiology of this occurence is unclear, it is postulated that before complete transection of the sympathetic trunk, continuous sympathetic stimulation to the stellate ganglions results in a reduction in the ventricular finrillation threshold, arrhythmia and cosequent cardiac arrest.
In an iteresting study of the delayed cardiac effects of T2-$ symtpathectomy, Drott and colleagues demonstrated significantly reduced heart rate at rest, and during both exercise and the recovery phase of exercise. Changes is the electrical axis and shortening of the QT interval have also been reported.

Irrespective of the technique used the reported incidence of postoperative pneumpthorax is variable, occuring in 2-15% of cases.
In a study by Gothberg, Drott and Claes, postoperative chest x-ray after 1274 procedures, in 602 patients demonstrated that a small apical pneumothroax was a usual occurence.

Conclusion: Because of the anaesthetic implications and possible surgical complications, many surgeons are reluctant to perform transthoracic sympathectomy.

British Journal of Anaesthesia 1997; 79: 113-119
B. Fredman, D. Olsfanger and R. Jedeikin

The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space

anatomic variations of the T2 nerve root

6 (9.1%) sides showed a single large ganglion formed by the stellate and the second thoracic sympathetic ganglia. The second thoracic sympathetic ganglion was most commonly located (50%) in the second intercostal space. Conclusion: The anatomic variations of the intrathoracic nerve of Kuntz and the second thoracic sympathetic ganglion were characterized in human cadavers.

Journal of thoracic and cardiovascular surgery Y. 2002, vol. 123, No. 3, pages 498-501 [bibl. : 14 ref.

http://www.refdoc.fr/Detailnotice?idarticle=9466218

"Please note, due to the complications of the ETS procedure and the few people who need it, ETS is NOT offered anymore at The Whiteley Clinic."

"Please note, due to the complications of the ETS procedure and the few people who need it, ETS is NOT offered anymore at The Whiteley Clinic."

http://www.sweating.co.uk/treatments_ETS-endoscopic-transthoracic-sympathectomy.htm
or archived page:

https://archive.today/PCmQf#selection-409.0-409.141

He had several websites promoting the procedure and used the media to advertise ETS:
http://www.sweating.co.uk/press-mark-whiteley.htm
or archived page:
https://archive.today/GKztq

Endoscopic Thoracic Sympathectomy (ETS) is major surgery with a high possibility of permanent damage and irreversible side effects

http://www.hyperhidrosisuk.org/treatment-options.html

after sympathectomy "He becomes more quiet, less impressionable, less agitated, tremor diminishes"

Everyone seems to agree that when sympathectomy is successful the subjective symptoms of the patient show a considerable improvement. He becomes more quiet, less impressionable, less agitated, tremor diminishes, tachycardia, however, is little influenced or not at all, and the same is true for goiter.
   In conclusion it may be said that the results obtained from sympathectomy when present are very immediate. The ocular symptoms are the ones most happily influenced by the operation; the others such as nervousness, tachycardia, and goiter are problematical.
   Remote Results.- In going over the cases operated by Jaboulay as far back as twelve and fourteen years, A. Charlier was able to find that a number of his patients had been cured completely. He was able to retrace 18 out of the 31 cases operated by Jaboulay from four to fourteen years before. Three of them were completely cured, 9 of them were so ameliorated that the subjective cure was a complete one, the objective cure, however, being incomplete; the 6 remaining cases were doubtful. All these patients experienced considerable benefit to their nervous symptoms; improved and no trophic disturbances of any sort followed as the result of sympathectomy.

Title	Thyroid and Thymus
Author	André Crotti
Publisher	Lea & Febiger, 1918
Original from	Harvard University
Digitized	17 Dec 2007
Length	567 pages

ffects of 6-hydroxydopamine on dopamine and noradrenaline content

Naunyn-Schmiedeberg's Archives of Pharmacology

Volume 329, Number 3 / May, 1985

P. Soares-da-Silva¹  and R. Davidson¹

(1)	Laboratorio de Farmacologia, Faculdade de Medicina, P-4200 Porto, Portugal

Received: 29 October 1984 Accepted: 27 January 1985 

6-OHDA and pargyline plus 6-OHDA induced a parallel decrease of the noradrenaline and dopamine content in the main trunk of the mesenteric artery, femoral artery and heart. In the proximal branches of the mesenteric artery, renal and splenic arteries 6-OHDA selectively reduced noradrenaline (by 50%) without changes in dopamine levels. Previous treatment with pargyline abolished this selectivity and depleted the tissue levels of both noradrenaline and dopamine by 75%.

The present findings suggest: an independent dopamine presence in the proximal branches of the mesenteric artery, renal artery and splenic artery; that noradrenaline and dopamine are in one and the same structure in the heart, femoral artery and the main trunk of the mesenteric artery; the saphenous vein is more resistant to chemical sympathectomy than arterial blood vessels; the changes in plasma catecholamine concentrations are probably related to a compensatory mechanism initiated at the adrenal medulla.

Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy

Neurogenic and non-neurogenic inflammation in t... [Neuroscience. 1991] - PubMed - NCBI: "Neuroscience. 1991;45(3):761-5.



Neurogenic and non-neurogenic inflammation in the rat paw following chemical sympathectomy.
Donnerer J1, Amann R, Lembeck F.
Author information
Abstract
Rats with chemical sympathectomy, induced either at neonatal age (long-term sympathectomy) or in adult animals (short-term sympathectomy) by guanethidine or by 6-hydroxydopamine, were used to determine the contribution of sympathetic noradrenergic fibres to afferent neuron-mediated responses and to non-neurogenic inflammation in the rat. Following long-term sympathectomy with 6-hydroxydopamine there was a 66% depletion of noradrenaline in the paw skin. This was accompanied by a 20-53% increase in the levels of sensory neuropeptides in the paw skin and sciatic nerve. A hypersensitivity towards heat stimuli was observed in the tail immersion test. "

Drawbacks of thoracoscopic sympathectomy | The BMJ

Drawbacks of thoracoscopic sympathectomy | The BMJ: "BMJ 2005; 330 doi: http://dx.doi.org/10.1136/bmj.330.7500.1127 (Published 12 May 2005)
Cite this as: BMJ 2005;330:1127
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Drawbacks of thoracoscopic sympathectomy

Side effects after thoracoscopic sympathectomy have been discussed
widely in Taiwan society in the past few months. Lots of people in Taiwan
suffer from hyperhidrosis palmaris. Thoracoscopic sympathectomy is covered
by our National Health Insurance, and yet patient billing for this
operation does not exceed US$ 60. This is why this operation is so popular
here (1). However, patients with serious compensatory sweating must change
clothes several times a day (some complain they change as often as 10
times a day), resulting in a serious impact on work and social
interaction. Patients suffering from such serious side effects in Taiwan
have formed a support group based on an Internet discussion forum to
request the government to take this problem seriously
(http://home.pchome.com.tw/family/vivi12175/). Since October 2004, The
Department of Health Executive, Yuan, Taiwan, has prohibited surgeons from
performing this operation on patients under 20 years of age. To our
knowledge, this type of Internet-based support group also exists in
England (http://www.noetsuk.com/), Sweden
(http://home.swipnet.se/sympatiska/index3.htm), Australia (http://www.ets-
sideeffects.netfirms.com/), Spain
(http://www.terra.es/personal8/hiperhidrosis/principal.htm) and Japan
(http://www.geocities.jp/etscontroversialop/index.html). Thoracoscopic
sympathectomy is a relatively safe and simple procedure, however, the side
effects are potentially devastating. All surgeons who do the operation and
individuals preparing to undergo this treatment should know this well.
1.Lin TS, Wang NP, Huang LC. Pitfalls and complication avoidance
associated with transthoracic endoscopic sympathectomy for primary
hyperhidrosis (analysis of 2200 cases). Int J Surg Investig 2001; 2: 377-
85."

An absence of afferent feedback concerning autonomically generated bodily states was associated with subtle impairments of emotional responses

nature neuroscience • volume 4 no 2 • february 2001 

Neuroanatomical basis for first- and second-order representations of bodily states
H. D. Critchley1,2, C. J. Mathias2,3 and R. J. Dolan1

"In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist"

8th ISSS Symposium New York, 2009: 

“In no other area than Sympathetic Surgery, disagreement, conflicting opinion, different definitions and misleading interpretations of the data exist. Mainly regarding surgical indications, the level and extent of the procedure and results evaluation”.

ATS Expert Consensus for the Surgical Treatment of Hyperhidrosis powerpoint presentation  – October 6, 2012, XVI Congreso Boliviana de Cirugia Cardiaca, Toracica y Vascular, Santa Cruz de la Sierra, Bolivia.

http://cirugiadetorax.org/2012/10/09/vats-sympathectomy-for-hyperhidrosis-dr-jose-ribas-de-milanez-de-campos/

or:

https://archive.today/Q047q

The Effects of Thoracic Sympathotomy on Heart Rate Variability in Patients with Palmar Hyperhidrosis

Compared with preoperative variables, there was a significant increase in the number of adjacent normal R wave to R wave (R- R) intervals that differed by more than 50 ms, as percent of the total number of normal RR intervals (pNN50); root mean square difference, the square root of the mean of the sum of squared differences between adjacent normal RR intervals over the entire 24-hour recording; standard deviation of the average normal RR in- terval for all 5-minute segments of a 24-hour recording (SDANN) after thoracic sympathotomy. Low frequencies (LF, 0.04 to 0.15 Hz) decreased significantly.
Yonsei Med J 53(6):1081-1084, 2012

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3481380/pdf/ymj-53-1081.pdf 

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic
http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566"

anatomical variations

"denervation of the T2-T3 thoracic sympathetic ganglia extends to the craniofacial region in 20.75% of cases, an area that is classically attributed to node T1."

Bronconeumol. 2003, 39: 19-22. - Vol 39 Núm.01

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased

Patients with surgical sympathectomies have low plasma levels of DA and NE [49], whereas EPI:NE ratios are increased (unpublished observations), suggesting decreased sympathetically mediated exocytosis and compensatory adrenomedullary activation.

Catecholamines 101, David S. Goldstein
Clin Auton Res (2010) 20:331–352

QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later - significant change after sympathectomy

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.

http://www.sciencedirect.com/science/article/pii/S0167527399001011

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block

The Change in Regional Cerebral Oxygen Saturation after Stellate Ganglion Block: "Korean J Pain. Jun 2010; 23(2): 142–146.
Published online May 31, 2010.



Background

Stellate ganglion block (SGB) is known to increase blood flow to the innervations area of the stellate ganglion. Near infrared spectroscopy reflects an increased blood volume and allows continuous, non-invasive, and bedside monitoring of regional cerebral oxygen saturation (rSO2). We investigated the influence of SGB on bilateral cerebral oxygenation using a near infrared spectroscopy.



Methods

SGB was performed on 30 patients with 1% lidocaine 10 ml using a paratracheal technique at the C6 level and confirmed by the presence of Horner's syndrome. The blood pressure (BP), heart rate (HR) and rSO2 were measured before SGB and 5, 10, 15 and 20 minutes after SGB. Tympanic temperature of each ear was measured prior to SGB and 20 minutes after SGB.



Results

The increments of the rSO2 on the block side from the baseline were statistically significant at 5, 10, 15 and 20 minutes. The rSO2 on the non-block side compared with the baseline, however, decreased at 15 and 20 minutes. The difference between the block and the non-block sides was significant at 15 and 20 minutes. The BP at 10, 15 and 20 minutes was increased and the HR was increased at 10 and 15 minutes. 




Conclusions

We observed an increment of the rSO2 on the block side from the baseline; however, the rSO2 on the non-block side decreased."

Inflammation in dorsal root ganglia after peripheral nerve injury: Effects of the sympathetic innervation

Following a peripheral nerve injury, a sterile inflammation develops in sympathetic and dorsal root ganglia (DRGs) with axons that project in the damaged nerve trunk. Macrophages and T-lymphocytes invade these gan- glia where they are believed to release cytokines that lead to hyperexcitability and ectopic discharge, possibly contributing to neuropathic pain. Here, we examined the role of the sympathetic innervation in the inflammation of L5 DRGs of Wistar rats following transection of the sciatic nerve, comparing the effects of specific surgical in- terventions 10–14 days prior to the nerve lesion with those of chronic administration of adrenoceptor antago- nists. Immunohistochemistry was used to define the invading immune cell populations 7 days after sciatic transection. Removal of sympathetic activity in the hind limb by transecting the preganglionic input to the rele- vant lumbar sympathetic ganglia (ipsi- or bilateral decentralization) or by ipsilateral removal of these ganglia with degeneration of postganglionic axons (denervation), caused less DRG inflammation than occurred after a sham sympathectomy. By contrast, denervation of the lymph node draining the lesion site potentiated T-cell in- flux. Systemic treatment with antagonists of α1-adrenoceptors (prazosin) or β-adrenoceptors (propranolol) led to opposite but unexpected effects on infiltration of DRGs after sciatic transection. Prazosin potentiated the influx of macrophages and CD4+ T-lymphocytes whereas propranolol tended to reduce immune cell invasion. These data are hard to reconcile with many in vitro studies in which catecholamines acting mainly via β2-adrenoceptors have inhibited the activation and proliferation of immune cells following an inflamma- tory challenge. 

Autonomic Neuroscience: Basic and Clinical 182 (2014) 108–117 

Neuroscience Research Australia, Randwick, NSW 2031, and the University of New South Wales, Sydney, NSW 2052, Australia

sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology

We studied the balance of activity of sympathetic, parasympathetic, and serotoninergic divisions of the autonomic nervous system in the regulation of the heart function in rabbits. High activities of the sympathetic and parasympathetic system are associated with antagonistic interactions between them. Moderation of activity of these systems could be accompanied by activation of the serotoninergic system. Physiological sympathectomy and parasympathectomy lead to hyperfunction of the serotoninergic system and pathology. 

Bulletin of Experimental Biology and Medicine, Vol. 140, No. 5, 2005 PHYSIOLOGY

"patient information must include the long-term substantial risk for severe CS and regret of the procedure"

http://www.ncbi.nlm.nih.gov/pubmed/22191130

lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli after sympathectomy

"lowering of heart rate and blood pressure, decreased responsiveness of the cardiocirculatory system to emotional stimuli: it is an effect that is especially noticeable in patients operated on for erythrophobia and less evident in those operated for hyperhidrosis. It is almost always a welcome phenomenon, which contributes considerably to the feeling of tranquility and serenity that generally supersedes anxiety. Excessive reduction in blood pressure or heart rate may lead to a state of weakness and fatigue that may require removal of the clips in approx. 2%. This rare state of asthenia contrasts with the increased energy and vigor that most patients experience when they feel freed from overwhelming anxiety."    

"The neurovegetative nervous system is, however, very dynamic and tends to adapt continuously during lifetime to all environmental or organic changes and conditions. Therefore, it reacts very individually when a reflex circuit has been blocked. The resulting side effects cannot be predicted in detail, and though they in most patients are relatively mild or even absent, there is a small group of patients developing heavy side effects. Therefore, surgery should only be considered in carefully selected cases in whom non-invasive treatment has failed and in whom the detrimental consequences of erythrophobia regarding the psychosocial situation and the quality of life is such to justify more adverse side effects. It should also always be kept in mind that therapy can be ineffective and that, in the long term, 10-15% of patients do not consider themselves satisfied with the result of surgery. In any case, the author prefers the use of a potentially reversible surgical technique (ESB), instead of destructive techniques (cutting, coagulation, removal of ganglia)."  

http://www.chir.it/en_erythrophobia.php

"Sympathectomy can enhance or suppress antibody production"

Neuropsychiatry - Google Books: "Neuropsychiatry
 edited by Randolph B. Schiffer, Stephen M. Rao, Barry S. Fogel"

The mechanisms by which sympathectomy leads to increased local bone loss is unknown

In vivo effects of surgical sympathectomy on intra... [Am J Otol. 1996] - PubMed - NCBI: "Am J Otol. 1996 Mar;17(2):343-6.
In vivo effects of surgical sympathectomy on intramembranous bone resorption.
Sherman BE1, Chole RA.
Author information
1Department of Otolaryngology--Head and Neck Surgery, School of Medicine, University of California, Davis, USA.
Abstract
Bone modeling and remodeling are highly regulated processes in the mammalian skeleton. The exact mechanism by which bone can be modeled at a local site with little or no effect at adjacent anatomic sites is unknown. Disruption of the control of modeling within the temporal bone may lead to various bone disease such as otosclerosis, osteogenesis imperfecta, Paget's disease of bone, fibrous dysplasia, or the erosion of bone associated with chronic otitis media. One possible mechanism for such delicate control may be related to the ubiquitous and rich sympathetic innervation of all periosteal surfaces. Previous studies have indicated that regional sympathectomy leads to qualitative alterations in localized bone modeling and remodeling. In this study, unilateral cervical sympathectomy resulted in significant increases in osteoclast surface and osteoclast number within the ipsilateral bulla of experimental animals. The mechanisms by which sympathectomy leads to increased local bone loss is unknown. Potential mechanisms include disinhibition of resorption, secondary to the elimination of periosteal sympathetics, as well as indirect vascular effects."



'via Blog this'

Chest wall paresthesia affects a significant but previously overlooked proportion of patients following sympathectomy

Paresthetic discomfort distinguishable from wound pain was described by 17 patients (50.0%). The most common descriptions were of ‘bloating’ (41.2%), ‘pins and needles’(35.3%), or ‘numbness’ (23.5%) in the chest wall. The paresthesia resolved in less than two months in 12 patients (70.6%), but was still felt for over 12 months in three patients (17.6%). Post-operative paresthesia and pain did not impact on patient satisfaction with the surgery, whereas compensatoryhyperhidrosis in 24 patients (70.6%) did (P=0.001). The rates and characteristics of the paresthesia following needlescopic VATS are similar to those observed after conventional VATS. Conclusions: Chest wall paresthesia affects a significant but previously overlooked proportion of patients following needlescopic VATS.



Eur J Cardiothorac Surg 2005;27:313-319"

very little is known concerning its direct vascular or indirect metabolic effects that will explain its success in some cases and its failure in others

Annals of Internal Medicine | THE HEMODYNAMIC EFFECTS OF SYMPATHECTOMY IN ESSENTIAL HYPERTENSION*: "Surgical sympathectomy has been employed so extensively for the treatment of essential hypertension that one might assume its hemodynamic effects to be completely understood. Quite to the contrary, however, very little is known concerning its direct vascular or indirect metabolic effects that will explain its success in some cases and its failure in others. Until these matters are fully understood the rationale for surgical treatment, and indeed for medical management, of essential hypertension must remain on an empirical basis. For this reason these problems have been and will continue to be the subject of long-term investigation in this laboratory."



'via Blog this'

The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable

The Surgical Treatment of Hyperhidrosis - The Annals of Thoracic Surgery: "The physiology of the sympathetic innervation of the limbs according to the ganglia and their location in correspondence with the ribs is highly variable. Surgery performed by rib count is not anatomical, and rib count is often erroneous: according to Chou and colleagues [3], the estimated rib level was wrong in 5 of 114 patients. "



'via Blog this'

although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating

JNS - Journal of Neurosurgery -: "The data demonstrate that the surgical removal of both the T-2 and the T-3 ganglia, although producing no alterations in the thermal balance, does produce abnormalities in quantitative distribution of thermoregulatory sweating in man."

the severity of post-sympathectomy (post-SE) dysfunction is unpredictable

"The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
METHODS:
Twenty eight patients with suspected SE were referred for TG to both legs. They completed our questionnaire on severity of difficulties after SE. We evaluated the ability of physical examinations to reveal the SE in contrast to TG and compared the symptoms (warmer leg and inhibited leg sweating) of SE with questionnaire responses as subjective measure and TG as objective measure.
RESULTS:
SE was diagnosed in 0.5% after ALIF at L5/S1, in 15% after ALIF at Th12-L5 and in 4% after XLIF at T12-L5. SE severely reduced the quality of life in two cases. The ability to distinguish differences in leg temperature by palpation after SE was found in 32%. All physical examinations together were insufficient for reliably disclosing SE. Subjective symptoms of SE were often false positive and proven SE by TG was often a clinically false negative.
CONCLUSION:
This is the first study to examine post-SE dysfunction objectivelya using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.
http://www.ncbi.nlm.nih.gov/pubmed/24263213"

most of the existing literature is geared towards assessing only the effectiveness of the surgical sympathectomy

"Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.



The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications."



Are We Paying a High Price for Surgical Sympathectomy? A Systematic Literature Review of Late Complications

http://www.jpain.org/article/S1526-5900%2800%2944124-6/abstract

33% of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'

Endoscopic thoracic sympathectomy for primary hyperhidrosis of the...IPG487 Safety: "Compensatory hyperhidrosis was reported in 92% (416/453), 86% (1720/2000) and 74% (1265/1700) of patients in 3 case series. In 2 of these studies 33% (557/1700 and 150/453) of patients reported compensatory hyperhidrosis that was either 'severe' or 'incapacitating'."

"He knows the procedure is controversial because of the unpredictability of side-effects"

Information about surgery for sweaty hands: "surgeon "knows the procedure is controversial because of the unpredictability of side-effects"

"Ferrar believes much of the controversy lies in surgeons, mainly in America, who perform the surgery on anyone who asks for it, rather than the severe end of the spectrum.
"In America there are so many that have been operated on when it hasn't been necessary, or the surgeon has given the patient false expectations, that there are support groups for people who've had complications or adverse effects. The people that come to me are almost self-selecting; they've tried everything else."
The youngest patient he has performed an endoscopic thoracic sympathectomy on was 8 years old, with most being in puberty (when the condition tends to arise). Or they are in their 20s when they are beginning relationships and jobs."

Publication info: Waikato Times [Hamilton, New Zealand] 07 Apr 2012: 22."

Effects of cervical sympathectomy, stage of the estrous cycle and estradiol treatment

C A CA Nagle, D P DP Cardinali and J M JM Rosner Life Sci 13(8):1089-103 (1973) PMID 4357690

Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia

"Sympathectomy is by no means a benign procedure, and sympathectomy for sweating can induce pain and allodynia at the border zone which is sometimes associated with pronounced increase in sweating in that area." (p. 534) Surgical Disorders of the Peripheral Nerves by Rolfe Birch Springer, Jan 21, 2011 - Medical - 512 pages original article published in Ann R Coll Surg Engl 2002; 84:181-184"

the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner

There are several reasons that stellate ganglion block affects the cardiovascular system. Stellate ganglion block will initially affect both the sympathetic and parasympathetic nervous systems based on the degree of block. The intensity of right stellate ganglion blockage of the sympathetic and parasympathetic nervous system will result in heart rate changes and altered activity of the sympathetic and parasympathetic nervous system. Efferent sympathetic innervation from the right stellate ganglion is primarily distributed over the sinus node of the heart, and the influence of the autonomic nervous system and left stellate ganglion block should be assessed. Further, results will be affected by the health status of participants.

Although efferent sympathetic nerves from the stellate ganglion are primarily distributed over the heart, efferent sympathetic fibers from the 2nd to 5th thoracic ganglia affect the heart as well. Accordingly, the autonomic nervous system of the heart is not completely dependent on the stellate ganglia. The influence of the autonomic nervous system cannot be excluded as well. It is worth noting that the mepivacaine in the present study was a lower dosage than those used in other studies. Finally, the autonomic nervous system varies in a unique, autonomous manner, and it is therefore difficult to assess changes in patients in a uniform manner or just through the application of one or two indicators. Future studies should examine diverse methods for the assessment of autonomic nervous system function.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2872892/

peripheral sympathectomy causes a dramatic increase in NGF levels in the denervated organs

Increased Nerve Growth Factor Messenger RNA and Protein

Peripheral NGF mRNA and protein levels following
sympathectomy
It has been shown previously that peripheral sympathectomy
causes a dramatic increase in NGF levels in the denervated
organs (Yap et al., 1984; Kanakis et al., 1985; Korsching and
Thoenen, 1985).
Increased ,&Nerve Growth Factor Messenger RNA and Protein
Levels in Neonatal Rat Hippocampus Following Specific Cholinergic
Lesions
Scott R. Whittemore,” Lena Liirkfors,’ Ted Ebendal,’ Vicky R. Holets, 2,a Anders Ericsson, and HBkan Persson
Departments of Medical Genetics and’ Zoology, Uppsala University, S-751 23 Uppsala, Sweden, and *Department of
Histology, Karolinska Institute, S-104 01 Stockholm, Sweden

Stratified analysis of clinical outcomes in ... [Ann Thorac Surg. 2008] - PubMed - NCBI

"Significant compensatory sweating in relation to the level(s) of sympathetic chain division occurred in T2 alone, 45%; T2 to T3, 30%; T3 to T4, 14%; T2 to T4, 38%; and more than three levels, 49%"



Ann Thorac Surg. 2008 Feb;85(2):390-3;

http://www.ncbi.nlm.nih.gov/pubmed/18222231

Surprisingly, many patients experienced mild recurrent symptoms within the first year

Sympathicotomy for isolated facial blushing:... [Ann Thorac Surg. 2012] - PubMed - NCBI: "Mild recurrence of facial blushing occurred in 30% of patients within the first year. One patient experienced Horner's syndrome. Compensatory sweating occurred in 93% of patients, gustatory sweating 36%, and dry hands in 66%; 13% of patients regretted the operation despite thorough preoperative selection and information."

Patients who undergo sympathotomy for hyperhidrosis will commonly report "clinically bothersome" compensatory hyperhidrosis.

J Thorac Cardiovasc Surg. 2014 Apr;147(4):1160-1163.e1. doi: 10.1016/j.jtcvs.2013.12.016. Epub 2014 Jan 2.

ETS is not without its critics

"ETS is not without its critics. Like any major surgical procedure, there is an operative risk, with a prominent fatality in Dublin a few years ago. Homer's syndrome can result. The most common problem is the development of 'compensatory hyperhidrosis', usually on the back. In 2003, ETS was banned in its birthplace, Sweden, due to overwhelming complaints by disabled patients."

Enabling freedom from hyperhidrosis

O'Keeffe, John. Irish Medical Times48.12 (Apr 4, 2014): 31.

Sympathectomy causes wall thinning, elongation, convolution, and aneurysm formation

"Sympathectomy causes basilar artery enlargment, which is beneficial for maintaining cerebral blood flow; however, it also causes wall thinning, elongation, convolution, and aneurysm formation, which may be hazardous in stenoocclusive carotid artery disease. Sympathectomy can prevent new vessel formation and hyperthyrophic changes at the posterior circulation. Neovascularisation is not detected adequately in sympathectomised animals."



Acta Neurochirurgica156.5 (May 2014): 963-9.

"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum

"The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice." in Legal Forum: "Cameron`s claim that there has been only one death attributable to synchronous bilateral thoracoscopic sympathectomy is implausible. Surgeons and anaesthetists are reticent in publicizing such events and Civil Law Reports of settled cases are an inadequate measure of the current running total. The custom of a majority is no guarantee of safety and is seldom a guide to best medical practice."

Jack Collin,
Consultant Surgeon
Oxford

http://www.bmj.com/content/320/7244/1221?tab=responses

Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head.

Google Translate:

Peripheral neuropathy gives reduced sensation and sweat ability of the arms and legs but can lead to compensatory sweating of the trunk and head.

Horner's syndrome due sympatikusskada means, for example Anhidrosis on one half of the face which can then be followed by compensatory hyperhidrosis on the other side. Harlequin syndrome is another name in the same condition in which instead focuses on the color difference where the sympatikusskadade page turns white and the other side is red with exertion. The look can then recall a home to Harelquin.

Freys'syndrom arise after salivary gland surgery faulty growing parasympathetic salivary fibers innervate the sweat glands in the cheek. This means that when the patient eats or even just thinking about food so producing a profuse perspiration from his cheek

Sympathectomy was common in the 90s in Sweden. At indications palmar and axillary hyperhidrosis, redness, or social phobia, burned the thoracic sympathetic ganglia endoscopically. Compensatory hyperhidrosis developed below the nipples of a large number of patients 1-6 months after sympatektomin.

the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere

The data indicate that the sympathetic fibers passing through the T2-3 ganglia play an important role in the elaboration or modulation of autonomic function elsewhere.

Journal of the Autonomic Nervous System
Volume 8, Issue 1, May 1983, Pages 33-43

This is the first study to examine post-SE (post-sympathectomy) dysfunction objectively

This is the first study to examine post-SE dysfunction objectively using TG after ALIF and XLIF, and the first to evaluate clinically, the severity of the post-SE syndrome. Before surgery we cannot foresee potentially poor SE results. For this reason, injury to the sympathetic chain during surgery must be avoided. The advantage of TG for identifying SE is its non-invasiveness and reliability.

The aim of this study was to identify retrospectively, lumbar sympathectomy (SE) using thermography (TG) and to evaluate clinically, the severity of post-sympathectomy (post-SE) dysfunction after anterior and lateral lumbar interbody fusion procedures (ALIF, XLIF).
http://www.ncbi.nlm.nih.gov/pubmed/24263213

Sympathectomy (ETS) a psychosurgery?

Financial Review - News Store: "It's not unusual to hear people who have undergone sympathectomies describe themselves as feeling emotionally "colder" than before. Among psychologists and neurologists alike there is concern, but no evidence, that the procedure limits alertness and arousal as well as fear, and might affect memory, empathy and mental performance. Professor Ronald Rapee, the director of the Centre of Emotional Health at Sydney's Macquarie University, says he's counselled several people who complain of feeling "robot-like" in the long-term wake of the operation. "They're happy they no longer blush, but they miss the highs and lows they used to feel.""



'via Blog this'

Dr. Telaranta treating fear, stuttering, stage fright, blushing with sympathectomy. Is ETS a psychosurgery?

Dr. Telaranta | Blog by Dr. Telaranta: "As a treatment, sympathetic blocking could be effective. Fortunately one can test whether it’ll have an effect, to a pretty high level of certainty, by first administering a temporary block t. Sympathetic block is usually effective in reducing all types of fear, why not also in reducing the fear of stuttering.

Sympathetic block typically has the highest likelihood of effective results on both schizophrenia and tremor when fear or anxiety plays a significant part in the onset of symptoms. It is also very effective in treating social phobia, stage fright and blushing. A stage fright-like fear of public presentations is likely common amongst those who stutter."



http://www.sympatix.fi/blog/?lang=en_

sympathectomy is based on such anecdotal observation and small case studies which have failed to stand up to scientific scrutiny

Clinical trials do exist and their inability to demonstrate effectiveness suggests an obvious conclusion: the argument for sympathectomy, by chemical or surgical means, is based on such anecdotal observation and small case studies which have failed to stand up to scientific scrutiny. To date there are no reproducible, blinded, randomized studies utilizing control populations which have demonstrated a benefit to sympathetic blockade in CRPS.

DISABILITY MEDICINE, The Official Periodical of the American Board of Independent Examiners,
Vol. 5 No. 3-4 July - December 2005
www.abime.org/documents/Journalv5n34.pdf

Surgical sympathectomy is rarely performed and its use remains controversial

Although improved in some, persistent or recurrent symptoms were present in all patients after six months postoperatively. Increased sensitivity of digital vessels to circulating catecholamines, nerve fiber regeneration or incomplete sympathectomy have been postulated to lead to recurrence. Five patients developed Horner's syndrome postoperatively. A portion of the stellate ganglion was intentionally resected in 3 of the 5 patients.
http://www.ncbi.nlm.nih.gov/pubmed/8370999

"synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy" - MAYO Clinic

http://www.mayoclinic.org/documents/mc5520-06pdf/DOC-20077566

change in sympathetic nervous system activity after thoracic sympathectomy

The photoplethysmographic (PPG) signal, which measures cardiac-induced changes in tissue blood volume by light transmission measurements, shows spontaneous fluctuations. In this study, PPG was simultaneously measured in the right and left index fingers of 16 patients undergoing thoracic sympathectomy, and, from each PPG pulse, the amplitude of the pulse (AM) and its maximum (BL) were determined. The parameter AM/BL is proportional to the cardiac-induced blood volume increase, which depends on the arterial wall compliance. AM/BL increased after the thoracic sympathectomy treatment (for male patients, from 2.60±1.49% to 4.81±1.21%), as sympathetic denervation decreases arterial tonus in skin. The very low-frequency (VLF) fluctuations of BL or AM showed high correlation (0.90±0.11 and 0.92±0.07, respectively) between the right and left hands before the thoracic sympathectomy, and a significant decrease in the right-left correlation coefficient (to 0.54±0.22 and 0.76±0.20, respectively) after the operation. The standard deviation of the BL or AM VLF fluctuations also reduced after the treatment, indicating sympathetic mediation of the VLF PPG fluctuations. The study also shows that the analysis of the PPG signal and the VLF fluctuations of the PPG parameters enable the assessment of the change in sympathetic nervous system activity after thoracic sympathectomy.

Medical and Biological Engineering and Computing

2001, Volume 39, Issue 5, pp 579-583
http://link.springer.com/article/10.1007%2FBF02345149

The graph shows an overall shorter survival rate of sympathectomised rats

Results

                Graph 1 shows the survival rate in both sympathectomised and non sympathectomised rats after the administration of YA cells. The graph shows an overall shorter survival rate of sympathectomised rats. In both groups there is a steep decrease in survival after 15 days, causing the median survival rate (18 days) of both groups to overlap. On the other hand the net survival rate is increased in non sympathectomised rates by 6 days

References:

1.        Ewa Chelmicka – Szorc, Barry G. W. Arnason. Effect of 6-Hydroxydopamine on Tumor Growth. CANCER RESEARCH 1976, 36, 2382-2384.

2.        Boris Mravec, Neurobiológia chorôb periférnych tkanív, Bratislava, SAP 2008, 220 s.,  ISBN 978-80-8095-030-9

3.        Raju B, Haug SR, Ibrahim SO, Heyeraas KJ. Sympathectomy decreases size and invasiveness of tongue cancer in rats. Neuroscience. 2007;149(3):715-25.

4.        Mravec B ,Gidron Y,Hulin I. Neurobiology of cancer: Interactions between nervous, endocrine

and immune systems as a base for monitoring and modulating the tumorigenesis by the brain. Seminars in Cancer Biology 18 (2008) 150–163.

5.        Paul G. Green,Wilfrid Janig, Jon D. Levinel. Negative Feedback Neuroendocrine Control of Inflammatory Response in the Rat is Dependent on the Sympathetic Postganglionic Neuron. The Journal of Neuroscience, 1997, 17(8):3234 –3238

6.      Aparna A. Bhanushali , R. Raghunathan , Rajiv D. Kalraiya , Narendra G. Mehta. Cancer-related anemia in a rat model: α2-macroglobulin from Yoshida sarcoma shortens erythrocyte survival. European Journal of Haematology 2002. 68(1),42 - 48

The effect of sympathectomy on the growth of intraperitoneally administered Yoshida ascitic cells in rats

El-Hassoun Olia, Coauthors: Zuzana Valašková, Ivan Hulín

Supervisor: Boris Mravec

Institute of Pathophysiology, LF UK Bratislava

http://svoc.fmed.uniba.sk/abstrakty/48/36.html

Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater

Bergerot, A; Aubineau, P; (1998) Long-term sympathectomy induces sensory and parasympathetic fibres sprouting, and mast cell activation in the rat dura mater. EUR J NEUROSCI , 10 79 - 79. 

http://discovery.ucl.ac.uk/1330488/

Lewis rats are much more likely to develop autoimmune disorders after sympathectomy

Lewis rats are much more likely to develop autoimmune disorders after sympathectomy 
(Dimitrova and Felten, 1995). This finding suggests that if sympathetic regulation were impaired in a 
genetically predisposed individual, an autoimmune disease might develop.  
Betrayal by the Brain: The Neurologic Basis of Chronic Fatigue Syndrome, Fibromyalgia Syndrome and Related Neural Network Disorders  
by Jay A. Goldstein  

published by The Haworth Medical Press, 1996

significant change after sympathectomy: reduced sympathetic and increased vagal tone

The HRV analysis showed a significant change of indices reflecting sympatho-vagal balance indicating significantly reduced sympathetic (LF) and increased vagal (HF, rMSSD) tone. These changes still persisted after 2 years. Global HRV increased over time with significant elevation of SDANN after 2 years. QT dispersion was significantly reduced 1 month after surgery and the dispersion was further diminished 2 years later.

http://www.sciencedirect.com/science/article/pii/S0167527399001011

"sympathectomy is a form of sensory neurectomy" (p. 1500)

Bonica's Management of Pain Scott Fishman, Jane Ballantyne, James P. Rathmell Lippincott Williams & Wilkins, 2010 - Medical - 1661 pages

more than 75% of the patients evolved with an improvement in facial hyperhidrosis - nonsurgical treatment works, just don't ask the surgeons

http://www.ncbi.nlm.nih.gov/pubmed/21738960

sympathectomized arteries become more susceptible to lipid accumulation

Combined effect of cholesterol feeding and sympathectomy on the lipid content in rabbit aortas

Atherosclerosis

Volume 37, Issue 4, December 1980, Pages 521–528

Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating

Removal of the clips from the sympathetic trunk does not provide resolution of compensatory sweating in 1 year of observation. T6-9 block does not provide remedy for compensatory hyperhidrosis. Regional abdomino-lumbar iontophoresis seems to be very promising, but further research and followup are mandatory.
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3458267/

Is sympathectomy safe and effective?

Well, it depends on who you ask.

We already know what the surgeons who offer the surgery have to say about it, as most of us was conned into having the surgery. We also know what these surgeons have to say about non-surgical options (ineffective, tedious, time-consuming, expensive, not permanent, resulting in disabling side-effects, very painful, useless - on one website patients are told that application of BOTOX requires general anaesthesia, just to scare them off that one... : http://archive.is/lSWd0 ). The question is answered very differently when you ask a medical professional who offers these non-surgical treatment options. Their advice and their version of FACTS always depends on the treatment and technique they have on offer. 

A very simple exercise: print out the texts from few of these websites and offer it to someone to read. Then let them guess what they think which treatment the medical professional is siding with, that is: which treatment is being offered and advertised by them. 

Here is a sample. You will most certainly detect that this medical professional is NOT offering ETS, as he selected different FACTS about the procedure and it's results.

http://www.lasertreatmentclinics.co.uk/Hyperhidrosis_Endoscopic_Sympathectomy/

and because you can never be safe enough, here is the archived version:

http://archive.is/ei7ft

Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses

Langley initially expected to find afferent cell bodies in autonomic ganglia, with projections to other ganglia. He believed that activation of these “autonomic afferents” should lead to purely autonomic responses. However Langley’s own careful work demonstrated that there were no such neurons.

The fundamentally important point is that integrative processes responsible for the organization of visceral function occur principally within the central nervous system (brain and/or spinal cord). Both somatic and visceral afferents result in complex, brain mediated, responses that include somatic and visceral function. Autonomic motor activity can be generated by both somatic and visceral inputs to the CNS, and visceral inputs to the CNS initiate responses that are both somatic and autonomic. Natural bodily functioning does not include “purely autonomic” or “purely somatic” responses, just as it does not include ‘purely sympathetic” or “purely parasympathetic” responses.

Bill Blessing and Ian Gibbins (2008), Scholarpedia, 3(7):2787.

revision #46085 [link to/cite this article]

Curator: Dr. Bill Blessing, Centre for Neuroscience, Flinders University, Adelaide, AUSTRALIA