Endoscopic transthoracic sympathectomy: successful in hyperhidrosis but can the indications be extended?

Endoscopic transthoracic sympathectomy (ETS) has recently become established as a successful treatment for severe palmar and axillary hyperhidrosis. In this unit the indications for ETS have been broadened to include patients with Raynaud's syndrome and critical upper limb ischaemia and this paper is primarily concerned with analysing outcome in relation to the indication for operation. In all, 68 operations have been attempted in 40 patients and complete follow-up details are available on 62 treated limbs. One operation was a technical failure because of an obliterated pleural cavity. In the hyperhidrosis group (n = 28), all the affected areas showed symptomatic improvement at a median follow-up of 17 months. In the Raynaud's group (n = 30), 28 limbs (93%) were improved to some degree at the time of discharge, but at a median follow-up of 18 months only 15 limbs (50%) remained symtomatically improved to some degree. The four upper limbs treated for critical ischaemia were improved by ETS and no amputations were necessary. Significant postoperative chest pain was noted by nine patients (23%). There were three postoperative pneumothoraces, two intercostobrachial neuralgias and one transient Horner's syndrome. The cosmetic result was reported as excellent or good by 97% of patients. As with other forms of surgical thoracic sympathectomy, excellent early results are not maintained in the longer term when ETS is used to treat Raynaud's syndrome. Nevertheless, the greater simplicity and lower morbidity of the endoscopic method suggest that it can be offered to Raynaud's sufferers with greater impunity than open sympathectomies.