"return of sweating in the hands is common occurrence in patients followed up for sufficient length of time"

Annals of the Royal College of Surgeons of England (1989) vol. 7.1

significant number of primary hyperhidrosis patients (more than 70%) were so pleased with the results that they decided to forgo the surgery

At the beginning of our study, thoracic sympathectomy was indicated indiscriminately to all primary hyperhidrosis patients. The authors observed a number of patients who were dissatisfied with the results obtained from this technique, particularly due to the undesirable but frequent side effect of compensatory hyperhidrosis. Hyperhidrosis is a condition that deeply affects the individual's emotional component, and many of them, despite being warned previously, are not psychologically prepared to address this new situation. The authors then included a psychologist in the study and directed the patients for routine psychological evaluations to prepare and better select them for surgery. In addition, the authors began to study a pharmacological formula to medicate these patients for the same purpose. Oxybutynin is an anticholinergic drug that has been used safely at high doses (up to 15 mg/day) to treat micturition disorders, and a side effect observed in these patients has been diminished sudoresis. Studies conducted by our group have documented the clinical benefits of a low dose of oxybutynin (10 mg/day). The authors found that a significant number of primary hyperhidrosis patients (more than 70%) were so pleased with the results that they decided to forgo the surgery [50-53].

Expert Review of Dermatology7.6 (Dec 2012): 529-538.

Neuralgia due to sympathectomy

Depending on the skill of the surgeon and difficulty encountered performing various intraoperative maneuvers, the incidence of complications following sympathectomy should be the same as that following any other extraperitoneal or extrapleural operation. However, a frequent complication following sympathectomy, and one which is apparently unrelated to operative technique, is that of postsympathectomy neuralgia.

This neuralgia is characterized by aching thigh pain after lumbar sympathectomy or aching shoulder and arm pain after cervical sympathectomy. The pain is intense in severity, sudden in onset and disappearance, and not related to any major neurologic manifestations.

Recently we have reviewed the files of the Vascular Surgical Service at the West Roxbury Veteran's Hospital and the literature on this condition. This report is a presentation of our findings.

Incidence  Pain following sympathectomy has been described as "an all too common complaint."⁸ Reports have varied in incidence from 2.1% to "practically every case."

http://archsurg.jamanetwork.com/article.aspx?articleid=560162

Autonomic neuropathy in the skin following sympathectomy

In diabetics with the anhidrotic syndrome, autonomic nerve fibres were studied in skin biopsies using argentic techniques and light microscopy. The Minor test was used to differentiate normal from anhidrotic skin areas. In the anhidrotic areas, histology of the nerve fibres showed beading, spindle-shaped thickening and fragmentation adjacent to the sweat glands. These changes were similar to those observed in two patients who had previously undergone lumbar sympathectomy. No abnormalities of the sympathetic nerve endings could be found in biopsies taken from normal areas of the forearm of the same patients. We conclude that the diabetic anhidrotic syndrome, a form of diabetic autonomic neuropathy, is due to a lesion of the sympathetic nerve supply to the skin.

I. Faerman¹, E. Faccio³, I. Calb², J. Razumny¹, N. Franco², A. Dominguez² and H. A. Podestá¹

Diabetologia

Volume 22, Number 2 / February, 1982

ciliospinal reflex

The ciliospinal reflex (pupillary-skin reflex) consists of dilation of the ipsilateral pupil in response to pain applied to the neck, face, and upper trunk. If the right side of the neck is subjected to a painful stimulus, the right pupil dilates (increases in size 1-2mm from baseline). This reflex is absent in Horner's syndrome and lesions involving the cervical sympathetic fibers. The enhanced ciliospinal reflex in asymptomatic patients with cluster headache is due to preganglionic sympathetic mechanisms.
http://en.wikipedia.org/wiki/Ciliospinal_reflex

The cilio-spinal center is not sharply confined to TI spinal level, but may extend downwards as low as T5

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1396202/pdf/annsurg00366-0044.pdf

financial interests may unduly influence professionals’ judgments

widespread relationships with industry have created significant risks that… financial interests may unduly influence professionals’ judgments.

“conflicts of interest” threaten the integrity of research, the objectivity of education, the quality of patient care, and public trust in medicine.

Conflict of Interest in Medical Research, Education, and Practice

Released:

April 21, 2009

Type:

Consensus Report

Topics:

Biomedical and Health Research, Education

Activity:

Conflict of Interest in Medical Research, Education, and Practice

Board:

Board on Health Sciences Policy

Endoscopic Sympathectomy is not minimally invasive

The term ‘‘minimally invasive surgery’’ was initially applied to coelioscopic procedures such as laparoscopic cholecystectomy and hernia repair, thoracoscopic sympathectomy, and arthroscopy, but has since been abandoned, because doing the same operation through a smaller incision is not necessarily less invasive. The term ‘‘minimally invasive parathyroidectomy’’ does not fully convey the nature of the techniques, and, as previously debated in the wider field of minimal-access surgery, carries connotations of increased safety that are not necessarily supported by the existing data [12].

Surg Clin N Am 84 (2004) 717–734

F. Fausto Palazzo, MS, FRCS(Gen),
Leigh W. Delbridge, MD, FACS*

Department of Surgery, Royal North Shore Hospital, Sydney 2065, NSW, Australia