Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing

  • Author: K. Smidfelt, C. Drott

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Sir,

Thank you Dr Hashmonai and colleagues for your comments and your question. We agree that compensatory sweating remains the major sequela after ETS. An analysis of whether the level and extent of denervation had an impact on the degree of compensatory sweating was made. There was no significant overall correlation but a tendency towards less compensatory sweating with less extensive denervation. Subgroup analysis was also performed but since the level and extent of denervation differed between indications and to some extent between surgeons and also changed over time we were, however, unable to draw any firm conclusions from the existing data.
Prospective randomized studies are needed to answer this important question.
  • Commentor: K. Smidfelt and C. Drott - Department of Vascular Surgery
  • Date: Feb 28, 2012

Sir,

We compliment Drs. Smidfelt and Drott, for their excellent and very important publication (1). This is the only long-term thorough follow-up of endoscopic transection of the sympathetic chain over the ribs (ETS) for primary hyperhidrosis and blushing, their series being the largest one ever reported. Compensatory sweating remains the major sequela of ETS, its pathophysiology is obscure, and no satisfactory solution exists. It has been suggested that lowering the level and/or reducing the extent of ablation might reduce this complication, but this is controversial and remains a matter of debate (2).

In this series, different levels of ablation have been used for treatment of similar areas of excess sweating. A specific analysis of the results for each level could supply important information about the correlation of the level of ablation and the outcome of surgery, both in terms of compensatory sweating and long-term success. The authors probably possess these important data. Analysis and publication could have a great impact on the worldwide performance of ETS, so we would very much appreciate further details.

References:
1. Smidfelt K, Drott C. Late results of endoscopic thoracic sympathectomy for hyperhidrosis and facial blushing. Br J Surg 2011; 98:1719-1723.

2. Kopelman D, Hashmonai M. The correlation between the method of sympathetic ablation for palmar hyperhidrosis and the occurrence of compensatory hyperhidrosis: a review. World J Surg 2008; 32:2343-2356.

Hashmonai M
Licht PB
Schick CH
Bishof G
Cameron AEP
Connery CP
De Campos JRM

On behalf of the International Society of Sympathetic Surgery (ISSS)
hasmonai@zahav.net.il

  • Commentor: Moshe Hashmonai - Technion - Israel Institute of Technology, Faculty of Medici
  • Date: Dec 26, 2011