Indications for sympathectomy - all of the following:
(1) severe sweating that has resulted in a poor quality of life
(2) severe sweating that has resulted significant disability
(3) failure of all nonsurgical modalities
Requirements:
(1) informed consent about possible complications
(2) distribution of sweating supplied by accessible sympathetic nervous tissue
(3) experienced surgeon
(4) minimally invasive (endoscopic) technique
The most common procedure is a thoracoscopic sympathectomy. Sympathectomy can also be done for primary hyperhidrosis involving the head and neck. Lumbar sympathectomy is not usually performed if there is risk for sexual dysfunction.
Eisenach et al describe the sympathotomy (sympathicotomy) procedure, in which the sympathetic connection between the T2 and stellate ganglion is cut. The T2 and T3 ganglia are preserved and there is a reduced incidence of complications.
