In a large study,3 T1-T4 endoscopic thoracic sympathectomies in 270 patients were found to be associated with rare acute severe side-effects such as pneumothorax (n = 11; 2%) Horner syndrome (n = 12; 2%), and ptosis (n = 7; 1%). These data are supported by other smaller studies. Chiou et al4 reported a haemothorax in one of 91 patients with transaxillar T2 sympathectomy.
There is a systematic review looking at the current indications for this intervention and the incidence of late complications, collectively and per indication. A total of 135 articles (no RCT) up to April 1998 reporting 22 458 patients were identified. The main indication found was hyperhidrosis, accounting for 84-3% of procedures. Compensatory hyperhidrosis occurred in 52-3% of patients, gustatory sweating in 32-3%, phantom sweating in 38-6% and Horner's syndrome in 2-4%. Compensatory sweating occurred three times more often after sympathectomy for hyperhidrosis.27
In the recent study of Herbst et al.,3 182 (67-4%) patients reported compensatory sweating, mostly on the feet and face. In the study of Chiou et al.,4 97% of 91 patients reported compensatory sweating in the first year, mostly on the upper back. Some patients might regret this procedure (13% of 91) because of this side-effect.4 In addition to compensatory sweating, Herbst et al.3 reported gustatory sweating in 50-7% of patients. In the same study 10% of patients reported an increased susceptibility to influenza and rhinitis.
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