Achievements of Unilateral Sympathectomy

Reply by the Authors of the Original Article

We read the article of Ravari et al titled “Unilateral Sympathectomy for Primary Palmar Hyperhidrosis.”[1] We thank them for drawing attention to unilateral sympathectomy.

In a study of our institution, we found compatible results with those of the authors. In our study, 56 of 272 patients did not need second operation.[2] Video-assisted thoracal sympathectomy is widely performed around the world and it is accepted as a safe procedure for palmar hyperhidrosis. However, we think that its complications must be taken into account.

Compensatory hyperhidrosis is a major complication of thoracal sympathectomy. Authors mentioned and argued this complication well. We want to point out the effect of sympathectomy to the pulmonary and cardiovascular system. Thoracal sympathetic system gives branches to plexus cardiacus and pulmonalis. Resection of bilateral sympathetic chain cuts off some fibers of these plexus. It is declared that after bilateral thoracal sympathectomy, heart rate and oxygen and carbon dioxide uptakes are decreased during maximal exercise.[3] Because of complex connections in sympathetic system, patients generally do not face symptomatic cardiac or pulmonary problems. However, the reductions of these parameters may affect individuals such as athletes and soldiers. As a result, we think that bilateral thoracal sympathectomy is more prone to such complications than unilateral thoracal sympathectomy. By performing unilateral sympathectomy, there is a chance of having bilateral dry hands and avoiding these complications.

We perform same operation to patients but we face different results. We think that this is because of not having the same distribution of the sympathetic fibers within the humans. In this context, when the interconnections of the sympathetic nerves are understood better, the results of this surgery will be estimated accurately.

• References

• 1 Ravari H, Rajabnejad A. Unilateral sympathectomy for primary palmar hyperhidrosis. Thorac Cardiovasc Surg 2015;
• 2 Görür R, Yıldızhan A, Türüt H , et al. Analysis of 530 sympathectomy operations performed for palmar hyperhidrosis and long-term results. Turkish J Thorac Cardiovasc Surg 2009; 17: 28-32
• 3 Vigil L, Calaf N, Codina E, Fibla JJ, Gómez G, Casan P. Video-assisted sympathectomy for essential hyperhidrosis: effects on cardiopulmonary function. Chest 2005; 128 (4) 2702-2705