I. Tarfusser
CdC Villa S. Anna, Merano, Italy
Clinical Autonomic Research, Volume 15, Number 2 / April, 2005
6th International Symposium on Sympathetic Surgery (ISSS) 4th–6th May 2005 University Campus Vienna Austria
Introduction: Thoracoscopic Sympathetic Surgery may produce side-effects which sometimes overshadow the desired result, in extreme cases inducing the patient to regret the operation. Despite disputes about its effectiveness, the compression method according to Lin has gained in popularity because of its potential reversibility. We present a series of sequential reversals after ESB and analyze frequency and causes of the reversal.
Materials and Methods: Between Jan 2002 and Jul 2003 (18 mo), among 261 ET surgeries, 189 were performed with neurocompression. 27 for Palmar Hyperhidrosis (PHH), 49 for Facial Hyperhidrosis (FHH) and 108 for Facial Blushing (FB). Technique: PHH - clips above and below T3; FHH - clip above T2 (37), below T2 (11), above and below T2 (1); FB - single clip above T2.
Results: Total removals were 13/189 (6.9%), with a predominance in the FHH group: 6/49 (12%). All of them requested removal due to unacceptable compensatory sweating (CS). 4 reported marked improvement by 1 year, 2 were unchanged. In the FB-group, 7/108 (6.5%) required removal, only 1 because of CS; the others due to asthenia (2), sinus bradycardia, excessively dry hands, personality change, fear of later sequelae. 4 were satisfied with the outcome of the reversal, 1 had no symptoms, 2 are still struggling. In the PHH-group, none had to be reversed.
Conclusions: 1) a regret rate hovering around 6-12% for FB and FHH, respectively, darkens the otherwise good clinical results of ESB; 2) CS is the dominant cause for regret in FHH patients, while it seems less important as a cause of reversal in the FB group; 3) an interruption below T2 in PHH reduces the regret rate; 4) in our experience, clamping offers a decent outlook for improvement after declamping, why we prefer it to destructive techniques, not least for psychological reasons.
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