Different outcomes between two sides after bilateral sympathetic ganglion interruption for hyperhidrosis

Department of Surgery, College of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan.
Surgical Neurology (Impact Factor: 1.67). 11/2006; 66(4):377-80; discussion 380-1. DOI: 10.1016/j.surneu.2006.03.042
Source: PubMed


Although the determination of the correct ganglion under direct vision through thoracoscopy by an experienced surgeon is almost unerring, there is still a 4.3% rate of clipping at the unintended level.
Through the review of the most recent patients (N = 117) with various sympathetic disorders undergoing thoracoscopic sympathetic interruption over different ganglions by clipping, we found that 5 cases were clipped at the unplanned level. The immediate manifestations were the different outcomes between both sides of the face, trunk, and extremities. The postoperative chest radiographs demonstrated the error.
All patients received a second operation in which the unintended clip was removed, and a new one was applied to the appropriate ganglion. The results were satisfactory.
Although the authors in this study have the experience of more than 1000 cases of hyperhidrosis, such an error is still inevitable. Luckily, by using the clipping method, the error is detectable and amendable.

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    ABSTRACT: Primary focal hyperhidrosis has a significant, negative impact on quality of life, causing impairments in social, physical, leisure, and occupational activities. The outcome of different surgical and medical treatment modalities is best assessed by using a combination of tools. Quantitative tools include gravimetry, evaporimetry, and Minor's starch and iodine test. Qualitative assessment tools include general health surveys and hyperhidrosis-specific surveys. Of these, the HDSS has been found to have a good correlation to other assessment tools and to be practical in the clinical setting. The surgical literature has primarily used qualitative tools to assess outcomes and many of these tools are investigator-developed, rather than standardized surveys, which may be partly because of the largely retrospective nature of these studies. A surgical investigator's goal tends to be focused on obtaining specific postoperative information regarding symptom improvement and potential surgical complications. The VATS can have a major positive impact on the quality of life of patients who have hyperhidrosis. The impairment that this disorder causes is often underappreciated by the medical community.
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