26.3% or one quarter of patients with compensatory hyperhidro-
sis considered the complication major and disabling. The average time between surgical sympathectomy
and the appearance of compensatory hyperhidrosis was 4 months (range 1-6 months). The inci-
dence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach.
Irrespective of approach, two or more levels of denervation and removal of the stellate ganglion produced
noticeably higher incidence. Finally, the incidence of this complication seemed to be 3 times higher when
the surgery was performed for primary hyperhidrosis than neuropathic pain.
The weighted mean incidence of gustatory sweating after upper extremity surgical sympathectomy was
32.3% (range 0-79) (information retrieved from 44 papers and 5,142 patients)
The phenomenon appeared on average 5 months
after surgery. The weighted means appeared substantially greater when the open approach was used, two
or more levels were denervated, the chain was electrocoagulated but left in situ and primary hyperhidrosis
was the indication for the intervention.
The weighted mean incidence of phantom sweating was 38.6 %
The weighted mean incidence of neuropathic pain complications was 11.9% .
Several issues regarding sympathectomy remain open, as the objectives of this review were limited and
specific. This review is geared exclusively around late complications and does not address efficacy or
effectiveness of the procedure. While the vast majority of patients were operated for palmar hyperhidrosis,
the procedure is obviously used for other indications, most importantly ischemia and neuropathic pain.
However, questions around satisfaction of patients with the procedure for a given indication or which
approach is the best for the same indication were not asked. Similarly, we are unable to answer questions
regarding completeness or permanency of the sympathetic denervation..
I S I S
SCIENTIFIC NEWSLETTER
Volume 4 Number 2
Summer Issue 2001
