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.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

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.

http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Saturday, May 30, 2009

Unforeseeable and unacceptable complications

Thorac Surg Clin. 2008 May;18(2):193-207.Links

Side effects and complications of surgery for hyperhidrosis.

Most of the difficulties associated with hyperhidrosis surgery are due to unavoidable side effects and unforeseeable and unacceptable complications. Careful patient selection is important before surgery so surgeons can avoid some of these pitfalls.

Patients should also be fully informed of all potential side effects and complications before surgical treatment.

the lack of uniform outcome measures makes these data difficult to interpret

The great majority of the currently available evidence supporting sympathectomy for primary hyperhidrosis is observational, coming from a variety of prospective and restrospective clinical series as well as comparative studies.
Thorac Surg Clin. 2008 May;18(2):209-16.Links

Evidence-based review of the surgical management of hyperhidrosis.

"Compensatory sweating' disastrous

World J Surg. 2008 Nov;32(11):2343-56.Click here to read Links

The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review.

Department of Surgery B, Ha'emek Hospital, Afula, Israel.

BACKGROUND: Upper dorsal sympathectomy achieves excellent long-term results in the treatment of primary palmar hyperhidrosis. Compensatory hyperhidrosis (CHH) remains an unexplained sequel of this treatment, attaining in a small percentage of cases disastrous proportions.

The search identified 42 techniques of sympathetic ablation. However, pertinent data for the present study were reported for only 23 techniques with multiple publications found only for 10. The only statistically valid results from this review point that T2 resection and R2 transection of the chain (over the second rib) ensue in less CHH than does electrocoagulation of T2. Further comparisons were probably prevented due to the enormous disparity in the reported results, indicating lack of standardization in definitions.

Hemodynamic consequences of cervico-dorsal sympathectomy


Hemodynamic consequences of cervico-dorsal sympathectomy
Thoracic sympathectomy has usually minimal consequences if unilateral, especially on the right side. For bilateral procedures, a mean 12% reduction of heart rate was reported [5]. Around 50% of patients have bradycardia in the following minutes of a bilateral surgery with mean and diastolic blood pressure significant reduction. Since the sympathectomy will block the chronotropic response, a significant increase of the ejection volume is observed when the patient moves in the erect position from dorsal decubitus [6].

Two cardiovascular complications were reported in the literature. First, an asystolic cardiac arrest in an 18-year-old woman during the second side (left) of bilateral sympathectomy for severe hyperhidrosis, requiring resuscitation maneuvers, with no chronic sequelae [7]. The second case was reported in a 23-year-old woman in whom a bilateral T2 sympathectomy was performed for facial hyperhidrosis. Two years later, following electrophysiologic studies confirming unopposed vagotonic stimulation, she underwent permanent pacemaker insertion for symptomatic bradycardia [8].


 6. Recommendations

Patients should be instructed of possible cardiovascular complications following this intervention.


http://icvts.ctsnetjournals.org/cgi/content/full/8/2/238

Cardiac arrest as a major complication of bilateral cervico-dorsal sympathectomy

Interact Cardiovasc Thorac Surg. 2009 Feb;8(2):238-9. Epub 2008 Nov 27.

O'Connor K, Molin F, Poirier P, Vaillancourt R.

Department of Cardiology, Institut universitaire de cardiologie et de pneumologie, Hôpital Laval, Québec, Canada. kim.oconnor.1@ulaval.ca

Severe palmar and/or axillary hyperhidrosis can be socially and psychologically very disturbing. We present a case of a patient who suffered from a 43 s asystolic cardiac arrest the night following a second contralateral thoracoscopic T(2)-T(3) sympathectomy for severe axillary and truncal hyperhidrosis. The cardiovascular effects of cervico-dorsal sympathectomy will be reviewed. Evaluation required to prevent such a serious cardiac complication will also be discussed.

PMID: 19038983 [PubMed - indexed for MEDLINE

statistically significant differences - cardiac effect

J Thorac Cardiovasc Surg. 2009 Mar;137(3):664-9. Epub 2008 Sep 24

Effects of endoscopic thoracic sympathectomy for primary hyperhidrosis on cardiac autonomic nervous activity.

Service of Cardiothoracic Surgery, Hospital de Santa Maria, Lisbon, Portugal. costacruzjorge@gmail.com

OBJECTIVE: Endoscopic thoracic sympathectomy is performed to treat primary hyperhidrosis. The second and third sympathetic thoracic ganglia excised also innervate the heart. Some studies have shown decreased heart rate but have not been conclusive regarding other cardiac effects of sympathectomy. We studied the cardiac autonomic effects of endoscopic thoracic sympathectomy in a group of patients with primary hyperhidrosis. Heart rate variability is a simple, noninvasive electrocardiographic marker reflecting the activity and balance of the sympathetic and vagal components of the autonomous nervous system. METHODS: We performed a prospective study in 38 patients with primary hyperhidrosis with 24-hour Holter recordings obtained before endoscopic thoracic sympathectomy and 6 months later. RESULTS: We found statistically significant differences (P < .05) in both time and frequency domains. Parameters that evaluate global cardiac autonomic activity (total power, SD of normal R-R intervals, SD of average normal R-R intervals) and vagal activity (rhythm corresponding to percentage of normal R-R intervals with cycle greater than 50 ms relative to previous interval, square root of mean squared differences of successive normal R-R intervals, high-frequency power, high-frequency power in normalized units) were statistically significantly increased after sympathectomy. Low-frequency power in normalized units, reflecting sympathetic activity, was statistically significantly decreased after sympathectomy. Low-/high-frequency power ratio also showed a significant decrease, indicating relative decrease in sympathetic activity and increase in vagal activity. CONCLUSION: These results provide, for the first time to our knowledge, clear evidence of increased vagal and global cardiac autonomic activity and decreased sympathetic activity after endoscopic thoracic sympathectomy.

PMID: 19258086 [PubMed - indexed for MEDLINE

Monday, May 25, 2009

40% were disappointed

We detected 8 patients (53%) complaining
about a decent to moderate recurrence of hand sweating and compensatory and gustatory sweating were observed in 9 (60%) and 5 (33%)
patients, respectively. Reported side effects related to surgery were paresthesias of the upper limb and the thoracic wall in 8 patients
(53%) and recurrent pain in the axillary region in one. At an average 12 years after surgery, 47% of patients were satisfied with the
treatment results, 40% were disappointed. Six patients (40%) affirmed they would ask for the operation if it were to be redone. Our
findings indicate that results of ETS deteriorate and compensatory sweating does not improve with time. It is mandatory to inform patients
of the potential long-term adverse effects before surgery.
􏰀 2009 Published by European Association for Cardio-Thoracic Surgery. All rights reserved.
Interactive CardioVascular and Thoracic Surgery 8 (2009) 54–57

Thursday, May 21, 2009

Sympathectomy = psychosurgery

http://encyclopedia.stateuniversity.com/pages/17971/psychosurgery.html
Cambridge Encyclopedia :: Cambridge Encyclopedia Vol. 60

Some consider use of endoscopic thoracic sympathectomy (ETS surgery) for patients with anxiety disorder to be
psychosurgery, despite it not being surgery of the brain.

"sympathectomy with little or no idea whether this is likely to produce benefit"

ANZ Journal of Surgery

Volume 45 Issue 4, Pages 425 - 434

Published Online: 21 Jan 2008

Journal compilation © 2009 Royal Australasian College of Surgeons


Proceedings of the Surgical Research Society of Australasia - SCIENTIFIC MEETING

"sympathectomy with little or no idea whether this is likely to produce benefit" - to be updated soon.

Causes of sexual dysfunction in the male

TABLE 2. Causes of sexual dysfunction in the male classified by clinical manifestation

Orgasmic dysfunction Drugs (selective serotonin reuptake inhibitors, tricyclic antidepressants, monoamine oxidase inhibitors,
substance abuse)
CNS disease (multiple sclerosis, Parkinson’s, Huntington’s chorea, lumbar sympathectomy)
Psychogenic (performance anxiety, conditioning factors, fear of impregnation, hypoactive sexual desire)

Male Sexual Function and Its Disorders: Physiology, Pathophysiology, Clinical Investigation, and Treatment
FOUAD R. KANDEEL, VIVIEN K. T. KOUSSA, AND RONALD S. SWERDLOFF
The Leslie and Susan Gonda (Goldschmied) Diabetes and Genetic Research Center, Department of
Diabetes, Endocrinology & Metabolism, City of Hope National Medical Center, Duarte, California
91010; and Department of Medicine, Harbor-UCLA Medical Center, Torrance, California 90502
Endocrine Reviews 22(3): 342–388
Copyright © 2001 by The Endocrine Society

sympathectomy as heart surgery (also)

JournalHeart and Vessels
PublisherSpringer Japan
ISSN0910-8327 (Print) 1615-2573 (Online)
IssueVolume 20, Number 4 / July, 2005

(1) Department of Cardiology, People’s Hospital of Peking University, Beijing, 100044, China
(2) Heart Center, Tongren Hospital, Beijing, China
(3) Department of Thoracic Surgery, Tongren Hospital, Beijing, China
(4) School of Biomedical Sciences, Charles Sturt University, Wagga Wagga, NSW, 2678, Australia

complications that can be catastrophic

Lumbar sympathectomy has been employed for over 75 years for the treatment of a variety of painful and circulatory conditions in the lower extremities. Chemical sympathectomy decreased the need for open surgical sympathectomy with less morbidity and mortality but still has risks and complications that can be catastrophic. The development of precise neurolysis with radiofrequency lesioning significantly decreased the risks of sympathectomy with results comparable to chemical and surgical neuroablation. Radiofrequency sympathectomy also allows repeat procedures without the risk of distorting the original anatomy.

Percutaneous radiofrequency lumbar sympathectomy
Techniques in Regional Anesthesia and Pain Management, Volume 8, Issue 1, Pages 53-56

Severe CS for 18% of patients

It was not necessary to remove the clips in any case. In our historical series of 300 patients submit-
ted to sympathicotomy we observed an improvement of the symptoms in 99% and CS in 78%, being severe in 18%.


162-P
EFFECTIVENESS OF SYMPATHETIC BLOCK BY CLIPPING IN THE TREATMENT
OF HYPERHIDROSIS AND UNCONTROLLABLE FACIAL BLUSHING
J.J. Fibla, L. Molins, J.M. Mier, G. Vidal
Thoracic Surgery Sagrat Cor University Hospital, Barcelona, Spain
2008;7:147-200
Interact CardioVasc Thorac Surg
Abstracts: Suppl. 2 to Vol. 7 (June 2008)

Sympathectomy increased the pain threshold and made the sympathectomized rats hypesthetic.

Spine:
15 April 1996 - Volume 21 - Issue 8 - pp 925-930
Anatomy

Latanoprost has been shown to abolish sympathectomy induced iris hypopigmentation

British Journal of Ophthalmology 1999;83:1403c; doi:10.1136/bjo.83.12.1403c
Copyright © 1999 by the BMJ Publishing Group Ltd.
Br J Ophthalmol 1999;83:1403 ( December )

Surgical or chemical sympathectomy leads to suppression of adrenergic and neuropeptide Y fibers.

Clinical Anatomy of the Nose, Nasal Cavity and Paranasal Sinuses
By Johannes Lang
Translated by P. M. Stell
Edition: illustrated
Published by Thieme, 1989

Injury of peripheral nerves often results in hyperalgesia

Injury of peripheral nerves often results in hyperalgesia (an increased sensitivity to painful stimuli). This hyperalgesia is mediated in part by sympathetic neurotransmitters. We examined the effect of neuropeptide Y (NPY), specific Y1 and Y2 agonists, and an NPY antagonist on peripheral hyperalgesia in rats whose sciatic nerves had been partially transected. NPY and the Y2 agonist, N-acetyl [Leu28,Leu31] NPY 24–36 exacerbated both mechanical and thermal hyperalgesia, while the Y1 agonist, [Leu31, Pro34]NPY relieved thermal hyperalgesia.

School of Anatomy, University of New South Wales, Sydney, NSW 2052, Australia

Brain Research
Volume 669, Issue 2, 16 January 1995, Pages 245-254

sympathectomy can itself trigger a painful syndrome

Finally, it should be noted that neuropathic, painful states are not invariably sympathetic dependent. Clinically, 'sympathetically maintained' and 'non-sympathetically maintained' states of pain can be differentiated, based on the fact that in some patients neuropathic pain can be relieved by sympathetic blocks. Furthermore, surgical sympathectomy can itself trigger a painful syndrome in some patients.
Pain medicine: the requisites in anesthesiology
By Stephen E. Abram
Edition: illustrated
Published by Elsevier Health Sciences, 2006

Results of ETS deteriorate

We describe a patient who underwent upper thoracic sympathectomy for palmar hyperhidrosis, and whose symptoms subsequently deteriorated, becoming worse than those on initial presentation.


Accepted for publication 6 January 1995

Clinical and Experimental Dermatology

Volume 20 Issue 3, Pages 230 - 233

Published Online: 27 Apr 2006

Sympathectomy on Neuropeptide Y

Neuropeptide Y (NPY)-immunoreactive nerve fibers were numerous around arteries and few around veins. NPY probably co-exists with noradrenaline in such fibers since chemical or surgical sympathectomy eliminated both NPY and noradrenaline from perivascular nerve fibers and since double staining demonstrated dopamine-β-hydroxylase, the enzyme that catalyzes the conversion of dopamine to noradrenaline, and NPY in the same perivascular nerve fibers.

Neuropeptide Y co-exists and co-operates with noradrenaline in perivascular nerve fibers


Regulatory Peptides
Volume 8, Issue 3, April 1984, Pages 225-235