http://www.bjs.co.uk/bjsCda/cda/microViewCorrespondence.do?DOI=10.1002%2Fbjs.4511&issueDOI=10.1002%2Fbjs.v91%3A3&vid=2
Dripping Silver
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Posts: 2265
(3/18/05 10:51 pm)
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ezSupporter
 Re: Unusual Complications Can Occur After ETS
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 Another rare complication but it can happen...the man had to have a finger amputated.....
Drawbacks of ETS

Drawbacks of endoscopic thoracic sympathectomy (p.264-269)
T. A. Ojimba, A. E. P. Cameron



W.T.Ng, Yan Chai Hospital, Hong Kong
May 22, 2004

Sir To their credit, the authors have presented what is probably the most comprehensive review of the complications of thoracoscopic sympathectomy in the English literature. Their diligent search was based on Medline and personal communications, and even isolated case reports, but appeared to exclude the laparoscopic and endoscopic surgical texts that have sprung up in rapid succession since the dawn of the laparoscopic era. Nonetheless, I could only find one English text, amongst 28 others, that mentioned temporary Raynauds phenomenon, a complication omitted by the authors; this occurred in 4/85 sympathectomies (1). Recently, I performed a thoracoscopic sympathectomy on a 33-year-old patient with scleroderma who had experienced severe pain from an indolent ischaemic ulcer at the tip of the left middle finger. The operation was uneventful, however, in the middle of the night, he complained of excruciating bursting pain in the finger. Thinking that the analgesic effect of the surgery had worn off, the on-call resident ordered an injection of pethidine. During the morning round, the middle finger was found to be grossly swollen and dusky. Ultimately, the gangrenous finger had to be amputated. Plausibly, the reactive hyperaemia (rebound Raynauds phenomenon) and the resulting oedema caused compression to the digital circulation under the thick and unyielding skin that characterizes scleroderma. Awareness of this unique complication and timely release of the tight skin might have averted the amputation. 

This case, previously mentioned in a letter-to-the-Editor without identifiable keywords, has eluded the authors Medline search (2). Can there be others? 

1. Geraghty JG, Tanner WA. Endoscopic sympathectomy. In Practical Laparoscopic Surgery for General Surgeons, Macintyre IMC (eds), Butterwoth-Heinemann, Oxford, 1994; 182-188. 2. Ng WT. Letter to the editor. Surg Laparosc & Percut Tech 2001; 11: 152-153.  