The technique of endoscopic thoracic sympathectomy: resection, clipping and cautery

IS THERE NEURAL AND FUNCTIONAL RECOVERY AFTER CLIP REMOVAL IN CERVICAL EXPERIMENTAL SYMPATHECTOMY?

Background:

The surgical treatment of hyperhidrosis by thoracic sympathectomy has brought, in addition to symptomatic relief for many, its main adverse effect: compensatory or reflex sweating. The clipping technique in place of the sympathetic nerve section gave rise to the hope of reversibility, but the positive results showed to be quite divergent, evidencing the academic deficiency regarding the study of this phenomenon.

Aim:

To observe micro and macroscopic damage caused by the polymer clip on sympathetic nerve of rabbits seven days after their clipping and the findings after three weeks of clip removal.

Method:

In this experimental study, 20 rabbits were divided into two groups of 10, group 1 (clipping) and group 2 (de-clipping). The right cervical sympathetic nerve of all animals was clamped with polymeric clip, and in group 2 the nerve was unclipped seven days later. Group 1 rabbits were induced to death on the 7th postoperative day, and group 2 on the 21st after removal of the polymer clip. Macroscopic variables were: clip appearance, presence of discontinuity lesion, infection and adhesions around the nerve. H&E was used in the evaluation of the phases and degree of the inflammatory process and presence of necrosis, and picrosirius red F3BA for quantification of collagen.

Results:

The cervical sympathetic nerve was intact, without necrosis or infection in all animals of the experiment; there were adhesions in both groups, being minimal in eight animals of each group and moderate or intense in two; the clip was completely closed in all animals at the 7th postoperative day; the inflammatory process shown was chronic, with monomorphonuclear predominance. There was no significant difference between groups regarding the intensity the inflammatory process, but the amount of collagen type I and type III was significantly higher in group 2.

Conclusions:

The injury caused by the polymer clip on the sympathetic nerve may be reversible, allowing functional return in the areas involved in the simulated cervical sympathectomy. Clipping of the cervical sympathetic nerve using a polymer clip does not cause discontinuity injury.

Factors affecting outcome following endoscopic thoracic sympathectomy

Background

Endoscopic thoracic sympathectomy (ETS) is an effective treatment for palmar hyperhidrosis and has been extended to craniofacial symptoms such as blushing and facial sweating. Adverse effects, including compensatory sweating, may cause patients to regret surgery. Such adverse events are currently unpredictable. This study investigated whether age, sex or bodyweight influenced the outcome.

Methods

A total of 110 patients who had bilateral ETS for palmar hyperhidrosis or facial symptoms (blushing or sweating) were asked to complete a questionnaire before and after surgery regarding physical and emotional symptoms, and overall satisfaction.

Results

Seventy-nine useable questionnaires were obtained. A decrease (an improvement) in physical symptom score was found in all patients; the median (interquartile range) change was − 15 (−9 to − 18) for facial symptoms and − 8 (−6·75 to − 9) for palmar symptoms. Similarly, there was an improvement in emotional symptom score of − 16 (−8 to − 28) for facial symptoms and − 13 (−7·25 to − 18·5) for palmar symptoms. More compensatory sweating was noted in those treated for facial symptoms (P = 0·007). There was no influence of age, sex or body mass index on outcome.

Conclusion

ETS is an effective treatment for palmar and facial symptoms. Side-effects may be worse in patients treated for facial symptoms.