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Langenbeck's Archives of Surgery

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01-01-2015 | Original Article

Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

Authors: Gregor J. Kocher, Anas Taha, Markus Ahler, Ralph A. Schmid

Published in: Langenbeck's Archives of Surgery | Issue 1/2015

Abstract

Purpose

Thoracoscopic sympathetic surgery is nowadays a broadly accepted technique in the treatment of primary hyperhidrosis as well as facial blushing. The objective of this study was to compare the two currently most commonly used methods for thoracic sympathicotomy: transection (ETS) and clipping (ETC.).

Methods

This is a retrospective study on a total of 63 patients, who underwent rib-oriented sympathicotomy, either by transection (n = 36, 57 %) or by clipping (n = 27, 43 %). Moreover, the up-to-date international literature is reviewed concerning which level(s) of the sympathetic trunk should be addressed, depending on the patients underlying condition. Furthermore, the highly controversial topic of reversibility of sympathetic clipping is debated.

Results

Our results confirm that clipping is at least as effective as transection of the sympathetic chain in the treatment of hyperhidrosis and facial blushing. Furthermore, the analysis of all larger studies on unclipping in humans shows a surprisingly high reported reversal rate between 48 and 77 %.

Conclusions

Depending on the symptoms of the patient, different levels of the sympathetic chain should be addressed. When a higher rib level such as R2 is approached, which more likely will result in moderate to severe compensatory sweating, clipping should be preferred as it seems that this technique has indeed a potential for reversibility. As demonstrated, this method is at least as effective as an irreversible transection of the sympathetic chain.

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Title: Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature
Authors: Gregor J. Kocher
Anas Taha
Markus Ahler
Ralph A. Schmid
Publication date: 01-01-2015
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 1/2015
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-014-1249-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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