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 10/1/2003; Publication: Journal of Drugs in Dermatology; Author: Stolman, Lewis P (no link available)

Excerpt from the article:

Sympathectomy or upper thoracic (T2) ganglionectomy is often offered to patients with severe palmar hyperhidrosis. Lumbar sympathectomy is not usually employed for plantar hyperhidrosis because of the risk of sexual dysfunction. Although the efficacy of this procedure in the treatment of palmar hyperhidrosis is not in doubt, with success rates of 9299%, the potential complications ate significant. Among the likely complications related (24% to 100% depending on the study) are compensatory hyperhidrosis (increased sweating in some other area of the body), gustatory sweating (sweating, usually of the face, related to the eating of foods), permanent Homers syndrome, wound infection, hemothorax, intercostal neuralgia, and recurrence of hyperhidrosis. The advent of endoscopic sympathectomy has reduced the incidence of many complications. 
Compensatory hyperhidrosis is the most common complication and the major reason for patient dissatisfaction with the procedure. Compensatory hyperhidrosis following sympathectomy can be far more life-disrupting than palmar hyperhidrosis in that afflicted individuals may have to change sweat-soaked clothing two or three times per day. In a recent systematic literature review of sympathectomy for the treatment of hyperhidrosis the question was asked, "Are we paying a high price for surgical sympathectomy?" 135 articles are reviewed, reporting on 22,458 patients and 42,061 procedures. 84.3% of the reported patients had the surgery for hyperhidrosis. Compensatory hyperhidrosis occurred in 52.3% of the patients, gustatory sweating in 32.3%, phantom sweating in 38.6%, and Horner's syndrome in 2.4%. In all, neuropathic complications occurred in 11.9% but were less common in patients who had the procedure for hyperhidrosis 

Moran (45) states it quite succinctly: "Complications related to the surgical approach, such as Homer's syndrome, brachial plexus injuries, pneumothorax, and painful scars may occur, while following sympathectomy compensatory hyperhidrosis is usual and hyperhidrosis may recur." 

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LEWIS P STOLMAN MD FACP FRCP (C) ASSOCIATE PROFESSOR OF PEDIATRICS, UMDNJ NEWARK, NEW JERSEY

ADDRESS FOR CORRESPONDENCE:

Lewis P Stolman MD FACP FRCP(C)

Dermatology and Laser Center of Northern New Jersey

290 South Livingston Ave

Livingston, NJ 07039

T: (973) 740-0101

F: (973) 740-0103

COPYRIGHT 2003 Journal of Drugs in Dermatology
COPYRIGHT 2003 Gale Group




Edited by: Dripping Silver at: 2/19/05 1:54 am
 