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Targeting Gray Rami Communicantes in Selective Chemical Lumbar Sympathectomy
Published on: January 10, 2019
Advantages of limited thoracoscopic sympathectomy
H J Bonjer1, J F Hamming, du Bois NAJJ
1Department of Surgery, University Hospital Dijkzigt, Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands.
Background:
Thoracoscopic resection of the first through the fourth thoracic sympathetic ganglion for palmary and axillary hyperhidrosis and Raynaud's syndrome is associated with a high initial success rate. However, the reported incidence of compensatory hyperhidrosis of the trunk and legs and Horner's syndrome are high. This study assesses the results of thoracoscopic sympathectomy limited to transection of the interganglionic trunk or resection of one or two thoracic ganglia.
Methods:
Twenty-eight thoracoscopic sympathectomies were done for dystrophy of the hand (n = 9), palmar and axillary hyperhidrosis (n = 6), and Raynaud's syndrome (n = 4). The extent of sympathectomy varied from interganglionic division between the second and third ganglion (n = 12), to resection of the third ganglion (n = 12), to resection of the second and third ganglion (n = 4).
Results:
Sympathectomy resulted initially in relief of symptoms in all cases. Horner's syndrome did not occur.
Conclusions:
After a median follow-up of 11 months, two of nine patients with dystrophy judged the result of operation as good. All patients with hyperhidrosis and Raynaud's syndrome judged the result of sympathectomy as good. Compensatory hyperhidrosis was experienced by two patients with dystrophy of the hand who had removal of the second and third sympathetic ganglion.
