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PubMed1999

Extensor pollicis longus paralysis following thoracoscopic sympathectomy.

Thoracoscopic sympathectomy is an acceptable form of treatment for palmar hyperhidrosis. Many authors have reported favourable results. Complications range from pneumo-haemothorax, Horner's syndrome, compensatory hyperhidrosis and bleeding. Plas et al reported 2.7% of the procedures had complications requiring intervention and 9.7% had non-interventive complications. There have been isolated reports of other rare complications including false aneurysm of intercostal artery, inferior brachial plexus injury and abnormal suntanning. We report an unusual case of isolated extensor pollicis longus paralysis after a thoracoscopic sympathectomy for palmar hyperhidrosis, in a fit young male. Such complications have not been previously reported. We recognise that such isolated nerve injury is uncommon.

Adult↗
PubMed1999

[Sympathectomy and intra-arterial perfusion therapy in critical ischemia of the lower limbs].

The results of 177 sympathectomies fulfilled in 152 patients with critical ischemia of the lower extremities are presented. Good and satisfactory results were obtained in 69.3% of patients after lumbar sympathectomy only. When the operation was combined with prolonged intraarterial catheter therapy positive effects were noted in 79.7% of the cases. This combined method of treatment is thought to be expedient for patients with the IV degree ischemia.

Adolescent↗
PubMed1999

[Minimal invasive lumbar sympathectomy].

Forty-four lumbar sympathectomies have been made on 42 patients by ROMICRO-set at the authors' department. This method--made by a specially developed lighting retractor system--ensures the same exposure as the traditional approach, but the visibility of the operative field is much better. The costs of the material character are low. Technique of the operation is discussed. Authors have got good experiences: there were no complications, postoperative pain is minimal, the time of the hospitalization is shortened. A special advantage of this new approach is that it can be even made on patients-belonging to ASA IV., and they can be operated on in epidural anesthesia. The authors recommend this new method only for those surgeons who are experienced in the technique of traditional lumbar sympathectomies.

Humans↗
PubMedDate not supplied

[Video-thoracoscopic sympathectomy in the treatment of Raynaud's disease and palmar hyperhidrosis].

BACKGROUND AND AIM: Raynaud's syndrome is a clinical entity characterised by episodic vascular spasm, digital ischemia in response to cold or emotional stimuli and hyperhidrosis. Many patients suffering from Raynaud's syndrome are successfully treated using medical therapy alone. Those patients who do not respond to medical treatment undergo surgery but the indications continue to be a source of controversy. A modern approach to thoracic sympathectomy requires a video-assisted technique. The aim of this study is to attempt to use mini-invasive type surgery to treat Raynaud's disease and hyperhidrosis in order to evaluate the real efficacy of thoracic sympathectomy in a large number of patients. The results of this method were compared for the two different pathologies in question. METHODS: The methodology used by this study is based on instrumental and clinical tests performed before and after surgery on treated patients using a comparative criterion and with a minimum 5-year follow-up. The pre- and postoperative diagnostic tests were performed by the vascular surgery laboratory and using a C.W. Doppler and a reflected light photoplethysmograph. Capillaroscopy and laboratory evaluations relating to secondary Raynaud's disease were carried out by internist type structures. The patients enrolled in the study responded to the following criteria: primary Raynaud's disease, palmar hyperhidrosis and associated syndromes. The population came from a mixed sociodemographic background, albeit within a strictly regional zone (Sardinia). A total of 42 patients were studied. The surgical technique used consisted of the ablation of thoracic ganglia from the 2nd to the 4th. RESULTS: The results showed a resolution of symptoms in 95% of patients treated for hyperhidrosis, whereas a 50% recidivation rate was observed in patients with Raynaud's disease alone, although symptoms were less intense. The results for Raynaud's disease were more disappointing, but it is important to remember that surgery is the ultimate choice for cases with advanced lesions which do not respond to medical treatment. Under these circumstances, the possibility of halting the evolution of the pathology represents an auspicious achievement. CONCLUSIONS: The authors affirm that mini-invasive surgical treatment of hyperhidrosis was resolutive during a mean follow-up of 3 years. It therefore represents a valid method which causes minimum esthetic damage to the patient and the greatest functional benefit. The postoperative period is short (about 3 days) and free of major complications. There is virtually no post-surgical pain.

Adult↗
PubMed1999

[Upper thoracic thoracoscopic sympathectomy as the method of choice for reoperation of the thoracic sympathetic nerve].

The authors present in their paper the possibility of thoracoscopic thoracic sympathectomy as the method of choice for reoperation of the thoracic sympathetic nerve 14 years after classical surgical upper chest sympathectomy, as the original effect had receded. They mention the possibility of reoperation of the sympathetic nerve with a subsequent favourable effect by the endoscopic method which reduces the risk of complications to a minimum.

Female↗
PubMed2000

[Lumbar sympathectomy in atherosclerosis obliterance of lower limb arteries and age of the patients].

In the elderly and old patients with atherosclerosis of lower limb arteries, ultrasonic dopplerography assisted study of hemodynamics in foot with use of Valsalva and corinfar tests was carried out. It is revealed that these patients retain high reaction to sympathetic influences. The obtained data were the base for use of lumbar sympathectomy in 419 patients over 65 years as an independent method of surgical treatment and in combination with reconstructive operations on major arteries. Good results were obtained in 70.1% operated patients, satisfactory results--in 22.7%. There were no significant differences in the results of lumbar sympathectomy between this age group and younger patients.

Age Factors↗
PubMed2001

[Endoscopic thoracic sympathectomy for palmar, axillary and plantar hyperhidrosis: intermediate-term results].

From June 1996 to June 2000, 477 endoscopic thoracic sympathectomies (ETS) were performed in 242 patients with palmar hyperhidrosis. Among these, 190 patients were studied who received bilateral sympathectomy (T 2-T 3 ganglionectomy) and were followed for over six months. There were 114 females and 76 males with a mean age of 26 years. Palmar hyperhidrosis was found in all patients and axillary hyperhidrosis in 138 (73%) and plantar hyperhidrosis in 186 (98%) preoperatively. The degrees of palmar, axillary and plantar perspiration were checked immediately (1-2 weeks, 190 patients), as well as in the early (1 year, 190 patients) and late (2-4 years, 65 patients) postoperative periods. In all patients, the hands became dry or normal condition immediately after the operation, and this continued to late period. Disappearance or decrease of axillary sweating was found in 128 patients (93%) in the immediate period and 107 patients (78%) in the early period. Disappearance or decrease of plantar sweating was found in 134 patients (72%) in the immediate period and 115 patients (62%) in the early period. Among 65 patients examined in the late period, axillary hyperhidrosis was found in 24 (37%), and plantar hyperhidrosis was found in 52 (80%). Compensatory sweating was found in 80 patients (42%) in the immediate period and 137 patients (72%) in the early period. In the late period, compensatory sweating developed in 56 patients (86%). In the immediate period, 175 patients (92%) were satisfied with the results of the operation, but this decreased to 83% and 72% at early and late period. However ETS was remarkably effective for palmar or axillary hyperhidrosis and relatively effective for plantar hyperhidrosis, but development of compensatory sweating did occur in some cases.

Adolescent↗
PubMed2001

Neonatal chemical sympathectomy attenuates fructose-induced hypertriglyceridemia and hypertension in rats.

Experiments were performed to determine the pathogenic contribution of the peripheral sympathetic nervous system to fructose-induced hypertriglyceridemia, hyperinsulinemia and hypertension in rats. Neonatal chemical sympathectomy was performed in neonatal Sprague-Dawley rats (1-week old) by administration of guanethidine (50 microg/g, i.p.) 5 times per week for consecutive 3 weeks and nerve-intact rats were served as controls. Both groups of rats were fed a fructose-enriched diet for 9 weeks. The systolic blood pressure (SBP) and body weight were measured weekly and arterial blood samples were taken weekly for determinations of plasma insulin, glucose and triglyceride levels. The results showed that fructose feeding for one week significantly increased SBP in intact rats and sympathectomized rats (116+/-1 to 119+/-1 mmHg and 116+/-1 to 120+/-1 mmHg, respectively). SBP further increased thereafter in both groups. However, the increased SBP levels were significantly higher in intact group than in sympathectomized group after 5 weeks of fructose feeding. Fructose feeding for one week concurrently produced hypertriglyceridemia that preceded the appearance of hyperinsulinemia in both groups. The elevated plasma triglyceride levels were significantly lower in sympathectomized rats than in intact rats after 3 weeks of fructose feeding, whereas the elevated plasma insulin concentrations were not different between groups throughout fructose feeding period. Plasma glucose concentrations of both groups were comparable and remained unchanged throughout the study. These data indicate that neonatal chemical sympathectomy attenuated, but did not prevent, fructose-induced elevations in blood pressure and plasma triglyceride levels, suggesting a partial dependency of fructose-induced hypertriglyceridemia and hypertension on the integrity of the peripheral sympathetic nervous system (SNS) in rats.

Animals↗
PubMed2000

Sympathectomy induces novel purinergic sensitivity in sciatic afferents.

AIM: To test the hypothesis that sympathectomy could induce novel purinergic sensitivity in sciatic afferents. METHODS: Teased-fiber recordings were made from 32 spontaneously active A afferents from the sciatic nerves in surgically sympathectomized rats and 30 spontaneously active A afferents from the sciatic nerves in intact rats. Adenosine 5'-triphosphate (ATP) was injected via a cannula in jugular vein. RESULTS: Twenty eight percent of the spontaneously active afferent fibers from sciatic nerves in the sympathectomized rats responded to ATP, either with an increase or with a decrease in spontaneous firing. However, none of the fibers from the sciatic nerves in the intact rats was activated by ATP. CONCLUSION: Sympathectomy induces novel purinergic sensitivity in A afferents from sciatic nerve.

Adenosine Triphosphate↗
PubMed2001

Endoscopic upper thoracic sympathectomy.

Thoracoscopic sympathectomy provides a superb surgical option for the many patients with incapacitating essential hyperhidrosis. Whether one thoracoscopic approach to sympathectomy is ever likely to prevail is doubtful, as the results of the various reported techniques seem to be quite similar. There are definite advantages to the single-port approaches, which are faster and usually do not require repositioning of the patient to do both sides. In the rare instances where dense apical adhesions are encountered or when significant bleeding is encountered from one of the intercostal vessels, the two- or three-port approaches definitely provide better control (see commentary in article by Kohno and Takamoto). Surgeon preference probably dictates which approach is used at the different centers. Compensatory sweating remains a frequent and sometimes serious complication of the procedure, particularly in individuals living in hot climates. An understanding of its mechanisms needs improvement, with the hope of preventing its occurrence in the future. In the meantime, patients have to be informed of its frequency, and operations could probably be tailored to the patients' needs and their local climate.

Humans↗
PubMed2001

Thoracoscopic sympathectomy in causalgia.

Causalgia, the post-traumatic pain syndrome remains one of the most poorly understood and frequently misdiagnosed entities encountered in clinical practice. Ablation of the upper thoracic sympathetic trunk has been used for over a century with variable success for a variety of conditions. Endoscopic transthoracic techniques of ablation of the sympathetic trunk have the advantage of a minimally invasive approach with excellent visualization of the sympathetic trunk and rapid postoperative recovery. We discuss a case of causalgia in a 35 years old man with 15 years duration of symptoms (stage 2 Drucker) in whom nonoperative therapy has consisted of drug therapy (phenytion, amitriptyline, carbamazepine, beclofen, ibuprofen and diclofenac Na), intermittent sympathetic blocks and physiotherapy failed, but full degree of pain relief was achieved by thoracic T2-T3 sympathectomy endoscopically without any major complication. Endoscopic transthoracic techniques for sympathectomy are a major technical advance in the management of causalgia and pancreatic pain. The operation is safe, effective and well tolerated and leads to a high level of patient satisfaction. Further applications of this technique are inevitable and are likely to replace conventional open procedures.

Adult↗
PubMed2000

[Partial sympathectomy for treating palmar hyperhidrosis with VATS].

OBJECTIVE: To review the experience with partial sympathectomy for treating palmar hyperhidrosis with VATS. METHODS: Between July 1995 and June 1999, 50 patients with palmar hyperhidrosis (26 males and 24 females, mean age 26.7 years) were operated. The major symptom was excessive sweating of hands, feet, and axcillaries, sometimes in drops. Thoracoscopy was performed under general anesthesia with a standard single-lumen endotracheal intubation with the patient in a semi-sitting position and arms stretched at 90 degrees. The approach through two small ports on the chest wall was done using VATS. As the lung was depressed by CO(2) insufflation in a low pressure, an excellent view of the upper mediastinum was obtained. Ganglia T(2) through T(4), sometimes T(5) were resected with a electrocautery probe. Bilateral procedures were completed in the same position. RESULTS: All patients after operation became dry immediately after sympathetic denervation with a few minor complications. Occasional side effect was moderate compensatory sweating of the trunk. One case had recurrence but sweating was much less than before operation. CONCLUSIONS: Because of excellent view of the upper mediastinum for sympathetic denervation of the hand and axcillaryies, the effect of partial sympathectomy for palmar hyperhidrosis is satisfactory and permanent.

Adolescent↗
PubMed2002

Uniportal and biportal endoscopic thoracic sympathectomy.

Sypathectomy for treatment of hyperhidrosis and pain syndromes of the upper extremities has recently evolved from invasive open procedures to endoscopic procedures. These minimally invasive techniques also have evolved, from complex staged procedures with multiple ports to more simplified biportal and uniportal procedures that require minimal tissue disruption and more limited yet effective sympathectomy procedures. We describe our techniques, experience, and results using endoscopic sympathectomy procedures with further reduced invasiveness, morbidity, and complications.

Humans↗
PubMed1976

Lumbar sympathectomy in the treatment of uncomplicated intermittent claudication.

The precise role lumbar sympathectomy plays in the treatment of uncomplicated intermittent claudication continues to be debated. Past experience at this institution indicates that lumbar sympathectomy has a definite positive role in uncomplicated intermittent claudication. A critical analysis of the 86 patients included in this study adds further support to this contention. Properly selected patients who undergo complete anatomic sympathetic denervation of the lower limbs continue to have very satisfactory results, as they have since 1947 in this institution.

Adult↗
PubMed2003

[Experiences with endoscopic thoracic sympathectomy].

PATIENTS AND METHOD: Thoracic sympathectomy using thoracoscopy was performed in 38 cases on 35 patients from January 01. 1996, till December 31. 2000. In 3 cases bilateral sympathectomy was carried out. The youngest patient was 18, the oldest was 76 years old, the average age was 42 years. The indications for surgery were Raynaud syndrome, causalgia, post-traumatic sympathetic dystrophy, thoracic outlet syndrome combined with vasospastic syndrome, Buerger syndrome, obliteration of digital arteries, embolism and hyperhidrosis. This method was chosen if conservative therapy was unsuccessful. Laparoscopic instruments are particularly suitable for minimal invasive interventions. RESULTS: Authors describe their operative technique whereby the postoperative pain and also the duration of hospitalisation can be reduced, and the cosmetic result can be improved. In two cases conversion was the only choice due to pleural adhesions. Pneumothorax occurred in two cases, haemothorax in one case and transient intercostal neuralgy was seen in 3 cases. In four cases sympathetic activity returned during the follow up. Ceasing the sympathetic innervation dilates the arterioles of the skin, and the temperature of the skin increases. During follow-up the complaints of the patients improved significantly, the progression became slower and clear improvement was found with instrumental investigations. CONCLUSION: This method can be recommended to every institute where the conditions for traditional laparoscopic surgery are given and staff is experienced in thoracotomy.

Adult↗
PubMed1992

[The clinical effect of intravenous regional sympathectomy with guanethidine in the management of sympathetically maintained pain].

We treated 25 patients suffering from sympathetically maintained pain with intravenous regional sympathectomy with guanethidine. Of these patients, 18 had reflex sympathetic dystrophy; 5 had causalgia; and 2 had shoulder hand syndrome. The visual analog scale before IRS therapy was 6.1 +/- 0.3, and after therapy, it was 2.3 +/- 0.4. The mean rate of improvement was 54.2% in reflex sympathetic dystrophy and 81.0% in causalgia. The therapy was particularly effective in patients with shoulder hand syndrome. These results suggest that intravenous regional sympathectomy with guanethidine could be effective for sympathetically maintained pain.

Adult↗
PubMed2003

[The significance of laser Doppler flowmetry for the prognosis and outcome evaluation of lumbar sympathectomy in patients with obliterating vascular arteriosclerosis of lower extremities].

The microcirculation state in lower extremities was studied using laser Doppler flowmetry in 37 patients with obliterating atherosclerosis before and after lumbar sympathectomy performance. It was established that laser Doppler flowmetry may be applied for estimation of the microcirculation bed functional state and prognosis of the lumbar sympathectomy results.

Arteriosclerosis Obliterans↗
PubMed2003

A systematic review of the outcomes of digital sympathectomy for treatment of chronic digital ischemia.

OBJECTIVE: To determine the effectiveness of digital sympathectomy for treatment of chronic digital ischemia, to provide information on outcomes of this surgical procedure, and to give recommendations for further investigations. METHODS: We conducted a systematic review of English language citations referring to digital sympathectomy published between 1966 and 2002 using Premedline and Medline. RESULTS: Multiple differences in surgical techniques, causes of digital ischemia, and outcome measurements among studies made comparisons of surgical outcomes difficult. We found that 14% of all patients required amputation and 18% of patients had ulcer recurrence. Some type of postoperative complication was reported in 37% of patients with systemic sclerosis. CONCLUSION: To best determine the effectiveness of this surgical procedure, we recommend that future studies are prospective, to include standardized pre- and postoperative measurements, stratify the study outcomes by diagnosis and disease duration, and have consistent postoperative followup intervals.

Adult↗