adverse effects and complications are not systematically reported

Studies (corresponding to 5,425 patients) classified compensatory hyperhidrosis either as minor (insignificant) or major (quite disabling). In these studies, 26.3% or one quarter of patients with compensatory hyperhidrosis 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). (82;93;118) The incidence of compensatory hyperhidrosis did not seem to be different after open or endoscopic approach.

The weighted mean incidence of gustatory sweating after upper extremity surgical sympathectomy was 32.3% (range 0-79)

The weighted mean incidence of phantom sweating was 38.6 % (range 0-59%), with data extracted from 13 papers (that specifically reported the phenomenon) and 1,539 patients.

The weighted mean incidence of neuropathic pain complications was 11.9% (range 0-87%),with data extracted from 37 papers and 1,979 patients.

Given the fact that most of the existing literature is geared towards a) assessing only the effectiveness of the surgical sympathectomy procedures, and b) publishing only studies with positive results, adverse effects and complications are not systematically reported but rather as a secondary outcome. It seems, therefore, highly likely that the complications as reported here, are truly underestimated.

The study indicates that surgical sympathectomy, irrespective of operative approach and indication, may be associated with many and potentially serious complications.

A Systematic Literature Review of Late Complications

Andrea Furlana,c MD, Angela Mailisa,bMD, MSc, FRCPC

(PhysMed) and Marios Papagapioua Msc