The amount of compensatory sweating depends on the patient, the damage that the white rami communicans incurs, and the amount of cell body reorganization in the spinal cord after surgery.
Other potential complications include inadequate resection of the ganglia, gustatory sweating, pneumothorax, cardiac dysfunction, post-operative pain, and finally Horner’s syndrome secondary to resection of the stellate ganglion.
www.ubcmj.com/pdf/ubcmj_2_1_2010_24-29.pdf

After severing the cervical sympathetic trunk, the cells of the cervical sympathetic ganglion undergo transneuronic degeneration
After severing the sympathetic trunk, the cells of its origin undergo complete disintegration within a year.
http://onlinelibrary.wiley.com/doi/10.1111/j.1439-0442.1967.tb00255.x/abstract

Monday, March 24, 2008

ARE WE PAYING A HIGH PRICE FOR SURGICAL SYMPATHECTOMY?

A Systematic Literature Review of Late Complications
Andrea Furlana,c MD, Angela Mailisa,bMD, MSc, FRCPC
(PhysMed) and Marios Papagapioua Msc
Comprehensive Pain Programaand Toronto
Western Hospital Research Instituteb,The Toronto Western Hospital, and Institute
for Work & Healthc, Toronto, Ontario,Canada.

In these studies, 26.3% or one quarter of patients with compensatory hyperhidrosis considered the complication major and disabling. The average time between surgical sympathectomy and the appearance of compensatory hyperhidrosis was 4 months (range 1-6 months). (82;93;118) The incidence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach. Irrespective of approach, two or more levels of denervation and removal of the stellate ganglion produced noticeably higher incidence.
We suggest that the
possibility of central contribution to the deregulation of sweat gland activity may be a substantial one and should constitute the subject of future research. Furthermore, our data suggest that the presence of a dysfunctional nervous system may constitute "vulnerability" to develop further neuropathic pain syndromes. Could this vulnerability be centrally mediated as well? What is the true nature of all other phenomena observed after sympathectomy (pathological gustatory sweating and what seems to be a rather innocuous complication, phantom sweating)? These and many other questions remain currently unanswered and should constitute similarly the focus of future research.
The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications.
note: There is no way for the surgeons who will end up with the disabling side-effect. Some of them attempt to guess, that it will be male and most of the time overweight. But there has been no research and there is no proof in the literature to support this claim. So who is a good candidate for ETS? There has been also no study into the severity of the side-effects, it is often the doctors or the patients who define. There is no objective study to establish the before and after state of these patients.