Surgical treatment for hyperhidrosis causes hyperhidrosis...

Localised hyperhidrosis may also be due to:

▪ Stroke

▪ Spinal nerve damage

▪ Peripheral nerve damage

▪ Surgical sympathectomy

▪ Neuropathy

▪ Brain tumour

▪ Chronic anxiety disorder

http://www.dermnet.org.nz/hair-nails-sweat/hyperhidrosis.html

Complications of surgical (Thoracic and Lumbar) Sympathectomy

Post-sympathectomy neuralgia - pain overlying the scapula

Compensatory sweating - involving the lover back or face

Pneumothorax

Bleeding due to azygos vein or intercostal artery injury

Winged scapula due to long thoracic nerve injury (p. 517)

Mastery of Vascular and Endovascular Surgery

Gerald B. Zelenock, Thomas S. Huber, Louis M. Messina, Alan B. Lumsden, Gregory L. Moneta

Lippincott Williams & Wilkins, 15/12/2005 - 900 pages

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

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

reduction in all proline-richproteins (PRP) in the saliva following sympathectomy

The protein constituents in parasympathetically evoked saliva from normal and short-term sympathectomized parotid gland swere compared. There was a reduction in all proline-richproteins (PRP) in the saliva following sympathectomy. The decrease was quantified for acidic PRP by high- performance ion-exchange chromatography, which showed an increase in the ratio of amylase to other proteins. These results suggest that sympathetic impulses influence the synthesis of PRP and amylase in opposite directions. 

Quarterly Journal ofExperimental Physiology (1988) 73, 139-142   

objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin treatment

Evaluation of objective methods to diagnos... [Clin Neurophysiol. 2004] - PubMed - NCBI: "objective methods to diagnose palmar hyperhidrosis and monitor effects of botulinum toxin treatment"

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No compensatory sweating after botulinum toxin... [Br J Dermatol. 2005] - PubMed - NCBI

No compensatory sweating after botulinum toxin... [Br J Dermatol. 2005] - PubMed - NCBI: "No compensatory sweating after botulinum toxin treatment of palmar hyperhidrosis"

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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

Another case of disabled thermoregulation and heatstroke following sympathectomy

We describe an extreme case of compensatory truncal hyper- hidrosis and anhidrosis over the head and neck region which led to a heatstroke. 

Six months after the initial operation, he had an episode of heatstroke while perform- ing outdoor duties which required running for around 5 km. The temperature on the day was between 30–32°C, and the relative humidity was between 75 and 85%. At that time, he complained of light-headedness, ‘feeling’ that heat could not dissipate from his head and neck region and muscle cramp in his legs. He was transferred to a hospital and was found to have a body tem- perature of 40°C and shock. His presentation was similar to a previous report by Sihoe et al. [1] on a patient with post- sympathectomy heatstroke. He was subsequently successfully treated with fluid and electrolyte resuscitation and supportive care.
  

Interactive CardioVascular and Thoracic Surgery 14 (2012) 350–352    

Sympathectomy has a negative risk-benefit balance

http://www.ncbi.nlm.nih.gov/pubmed/20027710

no chance for nerve regeneration as early as 10 days after clipping

*Study presented at the 9th Biannual International Society for Sympathetic Surgery Conference in Odense, Denmark in May 2011. 

www.tswj.com/aip/134547.pdf

69% of patients continued to have relief after ETS, patient satisfaction rate was 56%

There were no operative mortalities, minor complications occurred in 22%. Initial success rate was 88%. Median follow up was 93 (24-168) months, response rate to the questionnaire was 85%. Sixty-nine per cent of patients continued to have relief of initial symptoms, whereas patient satisfaction rate was 56%. CS was present in 42 patients (68%). Long-term satisfaction rates per initial indication group were 42% for facial blushing and 65% for hyperhidrosis (n.s.), and CS was present in 79% vs 61%, respectively.

CONCLUSION:

ETS appears a safe treatment for upper limb hyperhydrosis with acceptable long-term results. For excessive blushing, however, long-term satifaction rates of ETS are severely hampered by a high incidence of disturbing compensatory sweating. ETS should only be indicated in patients with unbearable symptoms refractory to non-surgical treatment. The patient information must include the long-term substantial risk for sever CS and regret of the procedure.

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

"sympathectomy highlighted the disparity between what is known in practice and what appears in the literature"

The March 2004 edition was quite outstanding, with an excellent editorial reminding the reader that only good results are published. The review on thoracoscopic sympathectomy highlighted the disparity between what is known in practice and what appears in the literature. 

‘Know Your Results’, the topic of the ASGBI Annual Scientific Meeting, is of outstanding importance; what is more, the surgeon has to go on knowing his/her results to ensure standards of practice do not slip.

The Journal appreciates comments and criticism and the correspondence column remains a crucial part of the BJS in its interaction between editors and reader. It is also part of the scientific process.

A more robust and incisive criticism of articles known to be flawed would prevent the retractions that have recently been published in the Lancet.

Christopher Russell, Chairman, BJS Society

Association of Surgeons of Great Britain and Ireland, ANNUAL REPORT 2004

The effect of bilateral sympathectomy was significantly greater than that of unilateral sympathectomy

The effect of bilateral sympathectomy was significantly greater than that of unilateral sympathectomy. Unilateral and bilateral sympathectomy produced similar reductions in the concentrations of NPY-ir and NA in the ventricular tissue. In contrast dissimilar changes were produced in the atrium. Although bilateral sympathectomy almost totally depleted the NA from the right atrium (by 98%), the NPY-ir levels were only reduced by 50%. These results indicate that approximately half the content of NPY in the right atrium is not present in sympathetic noradrenergic neurones. 

Maccarrone C, Jarrott B.

Source

University of Melbourne, Department of Medicine, Austin Hospital, Heidelberg, Vic., Australia.

J Auton Nerv Syst. 1987 Dec;21(2-3):101-7.

http://www.ncbi.nlm.nih.gov/pubmed/3450689

sympathectomy induced morphological alterations in the masseter muscles

Sympathectomized animals showed varying degrees of metabolic and morphological alterations, especially 18 months after sympathectomy. The first five groups showed a higher frequency of type I fibres, whilst the oldest group showed a higher frequency of type IIb fibres. In the oldest group, a significant variation in fibre diameter was observed. Many fibres showed small diameter, atrophy, hypertrophy, splitting, and necrosis. Areas with fibrosis were observed. Thus cervical sympathectomy induced morphological alterations in the masseter muscles. These alterations were, in part, similar to both denervation and myopathy. These findings indicate that sympathetic innervation contributes to the maintenance of the morphological and metabolic features of masseter muscle fibres.

http://www.ncbi.nlm.nih.gov/pubmed/11454103

Bilateral cervical sympathectomies should be avoided because of the destruction of cardioaccelerator tone

http://www.hiesiger.com/physicians/physicianrfl.html

Chylothorax as complication of sympathectomy

Chylothorax has been reported as a complication of wide range of other operations, including esophagoscopy, stellate ganglion blockade, thoracic sympathectomy, high translumbar aortography, lung resection, thyroid surgery, and spinal surgery.
http://www.mdconsult.com/books/page.do?eid=4-u1.0-B978-1-4160-4710-0..00074-2--s0250&isbn=978-1-4160-4710-0&type=bookPage&from=content&uniqId=350894912-2

SURGICAL SYMPATHECTOMY ON THE SENSITIVITY TO EPINEPHRINE OF THE BLOOD VESSELS OF MUSCULAR SEGMENTS OF THE LIMBS

Pursuing this study of the effect of epinephrine on muscle blood flow, Duff and Swan (10) reported that during intravenous epinephrine infusions the initial marked dilatation was succeeded by a second phase of moderate dilatation in normal but not in sympathectomized limbs. Because of its absence in chronically sympathectomized limbs this secondary vasodilatation was at that time thought to be an indirect vasomotor effect mediated by the sympathetic nerves. Re-examination of their data in the light of some subsequent critical experiments now reveals that the difference which they found between normal and sympathectomized limbs may be ascribed largely to vascular hypersensitivity in the later.

In the present paper these additional data are reported, and are incorporated with those of Duff and Swan(10); the whole material being interpreted to provide evidence that hypersensitivity of the vessels of skeletal muscle in the upper and lower limbs may result from pre- and postganglionic sympathectomy in man.

EFFECT OF SURGICAL SYMPATHECTOMY ON THE SENSITIVITY TO EPINEPHRINE OF THE BLOOD VESSELS OF MUSCULAR SEGMENTS OF THE LIMBS, ROBERT S. DUFF

J Clin Invest. 1953 September; 32(9): 851–857.

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC438413/