Complications of the Sympathectomy

Compensatory Hyperhidrosis

When Videoendoscopic Sympathectomy is performed, with the destruction of the sympathetic chain, the Hyperhidrosis in the superior members is extinguished, whether it is in the hand or in the armpit. However, the capacity to sweat does not disappear only in the armpit and in the hands, but also in the whole superior member and part of the thorax and neck. As the sweating is a form of regulating the temperature of the body, an increase of sweating in other parts of the body can be felt. This process is normal after a surgery and it is called Compensatory Hyperhidrosis. For most of the patients, Compensatory Hyperhidrosis is light and it can disappear after some time. This condition is acceptable and the patient has a better situation than the initial problem of axillary and palmar Hyperhidrosis that motivated the surgery.

However, in a smaller percentage of cases, around 5 to 10%, Compensatory Hyperhidrosis is unpleasant and in rare cases worse than the previous situation. Some patients complain about sweating in the abdominal region , on the back, in the inguinal area, part of the face, or in the feet. The Compensatory Hyperhidrosis does not depend on the surgeon's expertise, because it is not only a complication, but a side effect of the treatment that can happen in different ways for each patient.

Some patients feel so disturbed by the Compensatory Hyperhidrosis that they would like to revert the surgery. This is not possible nowadays, although some attempts have been made in other countries, but with poor results.
In some cases, injections of Botulinum Toxin (BOTOX® / Dysport) can improve Compensatory Hyperhidrosis.
When we use injections of Botulinum Toxin for the treatment of Hyperhidrosis, there is no risk of Compensatory Hyperhidrosis since the treated area is not the whole superior member as in Sympathectomy. The treatment with Botulinum Toxin is performed in a smaller area, corresponding to the Armpit or the Hand. This is the main reason why we prefer the Botulinum Toxin (BOTOX® / Dysport) to Sympathectomy to treat Hyperhidrosis.

Gustatory Hyperhidrosis

Another potential side effect is the gustatory sweating. Patient that develop this type of problem increase the sweating when they are eating. This happens in approximately 5-10% of the patients, but it is rarely severe.

Syndrome of Horner

Another fortunately very rare problem that can be a side effect of a Sympathectomy is the syndrome of Horner. That means the the drop of the eyelid. These complication although rare, is irreversible.
There is a ganglion called “sttellate” , from where nervous fibers that are responsible for maintaining the eyelid open come off. During a Videoendoscopic Sympathectomy for Hyperhidrosis, due to alterations of the anatomy or due to the heat of the cauterization of the vases close to the sttelate ganglion, this ganglion can be damaged during the surgery. As a result, an inadvertent lesion of this ganglion can happen.
Such situation does not depend on the surgeon's expertise; it could happen even when the surgeon takes the maximum of care. Although it is a very rare situation, it can happen in numbers that vary from 1 to 5% of the surgeries performed. Although rare, it is the most feared complication of the surgery of videoendoscopic Sympathectomy.

General Risks

Other complications as bleeding (hemotorax) and perforation of the lung (pneumotorax) can happen, but they are rare and treatable. There may be cases of complications resulting from the anesthesia, although in their majority, they are controllable. The infection is rare, but there is a risk. Because an endoscope and instruments are passed between the ribs, it is possible to damage an artery, a vein or a nerve that run under each rib. This could potentially lead to a bleeding or inflammation of the nerve with chronic irritation or pain.

Although most of these operations are performed in young adults, older patients are exposed to larger probability of complications when they undergo this procedure. These patients are subject to the risks of heart problems (heart attack, abnormal rhythm), pneumonia, clot, and infections and urinary infections. The incidence of any of these potential complications is very low (1% or less) but such problems can appear with any surgery form, and the patients should be aware of all of the risks involved. Lung adherences can hinder or impede the treatment, increasing risks.

Justifying our position

Many patients are benefitted by the Sympathectomy, but some few ones are not. As there are unexpected situations that do not depend on the doctor who performs the procedure, we prefer treating Hyperhidrosis with the Botulinum Toxin (BOTOX® / Dysport). This is our choice because the procedure does not cause Compensatory Hyperhidrosis, Syndrome of Horner, or surgical complications. If the choice is safety, the best option is the Botulinum Toxin (BOTOX® / Dysport). If the choice is the fact of being definitive, the best option is Sympathectomy . 12. Sympathectomy X Botulinum Toxin (BOTOX® / Dysport) .

Most of the patients who are submitted to the Sympathectomy can benefit from it, but others can not. The number of patients who develop Compensatory Hyperhidrosis and who are unhappy with the results can reach 10%. Besides, this is a condition that is frequently not reversible.

Many patients are benefitted by the Sympathectomy, but some few ones are not. As they are unexpected situations that do not depend on the doctor who performs the procedure, we prefer treating Hyperhidrosis with the Botulinum Toxin (BOTOX® / Dysport). This is our choice because the procedure does not cause Compensatory Hyperhidrosis, Syndrome of Horner, or surgical complications. If the choice is for safety, the best option is the Botulinum Toxin (BOTOX® / Dysport). If the choice is the fact of being definitive, the best option is Sympathectomy . "Although we recognize the risks of the videoendoscopic Sympathectomy are rare, we state that no doctor can say they do not exist. That’s the reason why we have chosen the treatment with injections of Botulinum Toxin (BOTOX® / Dysport) to control Hyperhidrosis. We have not suggested or performed Sympathectomy as a treatment for Hyperhidrosis. In the future, if the method proves to be safer and more previsible in relation to its complications, we can review our position " . This is the opinion of Naturale Clinic’s medical team, which has already been clearly declared in publications in medical magazines and presented in Congresses as well. However, we remind that other points of view are accepted by the medical and scientific community, including the practice of the Sympathectomy, that is performed by many institutions in Brazil and in other countries. This is a subject that is still in development and in debate.

Naturale Clinic’s Treatment

Many patients can benefit from the Sympathectomy, but some few ones can not. As the problems resulting from the surgery are unexpected and do not depend on the doctor who performs the surgery, we prefer to treat Hyperhidrosis with the Botulinum Toxin (BOTOX® / Dysport) because it does not cause neither Compensatory Hyperhidrosis nor Syndrome of Horner, and there are no surgical complications.
If the choice is safety, the best option is the Botulinum Toxin (BOTOX® / Dysport) injection. If the choice is the fact of being definitive, the best option is Sympathectomy, in spite of its important risks and possible complications.

Considering the absence of risk and complications and the easiness of the procedure, we preferred the Toxin Botulinum (BOTOX® / Dysport) to Sympathectomy in our Clinic.

 

 

2 efficient techniques e xist to treat Hyperhidrosis The Toxin Botulinum The Sympathectomy The Toxin Botulinum , that we preferred, has few risks, but it is not definitive, the sympathectomy is definitive, but has larger risks and complications. Considering this, as the two techniques are differents, and both are efficients, the doctor should explain to the patient the advantages and disadvantages of each technique and the choice of the techinique should be by the doctor's option and by the patient option.

 

 

Sympathectomy The main advantage of Sympatectomy, is that it is a definitive procedure. The disadvantages are the risks of the surgery, Compensatory Hyperhidrosis, the Syndrome of Horner, Pneumotorax, Hemotorax, the asymmetry of results, incompleted results , anesthetic complications, need of hospitalar internment , anesthesia general, it is not reversible, it is a technique of larger complexity and it uses complex material. The Toxin Botulinum Toxin Botulinum's main disadvantage is that it is not a definitive procedure, has a relatively high cost for not being definitive, and it presents a small index of poor results The main advantages are: It is a ambulatory procedure l, that doesn't need internment, it is reversible, it is simple, the material is simple, the technique has low risk, it doesn't provoke compensatory hyperhidrosis, it doesn't have Syndrome of Horner, it doesn't have surgical complications, it is performed under local anesthesia, at the clinic.

 

 

Na Clínica Naturale , preferimos a Toxina Botulínica porque é um tratamento simples, para um problema simples.

 

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