Thorac Cardiovasc Surg 2015; 63(08): 727
DOI: 10.1055/s-0035-1548745
Letter to the Editor
Georg Thieme Verlag KG Stuttgart · New York

Achievements of Unilateral Sympathectomy

Sezai Cubuk
1  Department of Thoracic Surgery, Gata Medical Faculty, Ankara, Turkey
Orhan Yucel
2  Department of Thoracic Surgery, Gata Haydarpasa Teaching Hospital, Istanbul, Turkey
› Author Affiliations
Further Information

Publication History

26 January 2015

09 February 2015

Publication Date:
18 May 2015 (online)

Reply by the Authors of the Original Article

We read the article of Ravari et al titled “Unilateral Sympathectomy for Primary Palmar Hyperhidrosis.”[1] We thank them for drawing attention to unilateral sympathectomy.

In a study of our institution, we found compatible results with those of the authors. In our study, 56 of 272 patients did not need second operation.[2] Video-assisted thoracal sympathectomy is widely performed around the world and it is accepted as a safe procedure for palmar hyperhidrosis. However, we think that its complications must be taken into account.

Compensatory hyperhidrosis is a major complication of thoracal sympathectomy. Authors mentioned and argued this complication well. We want to point out the effect of sympathectomy to the pulmonary and cardiovascular system. Thoracal sympathetic system gives branches to plexus cardiacus and pulmonalis. Resection of bilateral sympathetic chain cuts off some fibers of these plexus. It is declared that after bilateral thoracal sympathectomy, heart rate and oxygen and carbon dioxide uptakes are decreased during maximal exercise.[3] Because of complex connections in sympathetic system, patients generally do not face symptomatic cardiac or pulmonary problems. However, the reductions of these parameters may affect individuals such as athletes and soldiers. As a result, we think that bilateral thoracal sympathectomy is more prone to such complications than unilateral thoracal sympathectomy. By performing unilateral sympathectomy, there is a chance of having bilateral dry hands and avoiding these complications.

We perform same operation to patients but we face different results. We think that this is because of not having the same distribution of the sympathetic fibers within the humans. In this context, when the interconnections of the sympathetic nerves are understood better, the results of this surgery will be estimated accurately.