The importance of classification in sympathetic surgery and a proposed mechanism for compensatory hyperhidrosis: experience with 464 cases

Abstract

Different procedures are recommended for different sympathetic disorders according to the classification. The higher the level of sympathetic ganglion blockade, the higher is the regret rate. Therefore, for T2 and T3 ganglion, endoscopic thoracic sympathetic block by the clipping method is strongly recommended because of its reversibility.

Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

“…Some have argued that clipping cannot be considered to be a reversible technique (15,16), while others have suggested that clips should be removed between the first ten days and the first month after sympathetic clipping to ensure recovery of the sympathetic nerves (6,17). We assume that clipping removal was not done in time for reversal; therefore, we also believe clipping removal is not a reversible technique.…”

“…For palmar hyperhidrosis, there is a slightly higher risk of CS with an R3 interruption but a risk of moister hands with an R4 interruption. Patients feel more comfortable when a certain minimal moistness is maintained and complete exsiccation is avoidable (8,17,21).…”

Thoracic Aortic Injury Due to Thoracoscopic Sympathectomy: A Case Report

“…The surgeon needs adequate and continuous relaxation to prevent injuries during the surgery. The most common side effect of this method is compensatory sweating due to thermoregulatory mechanisms [5]. Pneumothorax, haemothorax, chylothorax, pleural effusion, lung injury, Horner's Syndrome, nasal obstruction, rhinitis, wound infection, and intercostal neuralgia may be seen intra-and peri-operatively.…”

Hyperhidrosis: clinical presentation, evaluation and management

“…The mechanism whereby CS occurs is unclear, but it is thought to occur due to an abnormal thermoregulatory response after sympathectomy, whereby residual sweat glands increase their activity in an attempt to compensate for the loss of neural regulated sweat glands. It is also possible that CS occurs due to an altered feedback mechanism in the hypothalamus [53]. The intensity of CS is subjective and can vary among patients from mild to disabling.…”