Sympathektomi

Sympathektomi, or sympathectomy, is a surgical procedure that interrupts part of the sympathetic nervous system to reduce sympathetic outflow to a targeted region. The operation can involve cutting, clipping, or destroying segments of the sympathetic nerve pathways, most commonly along the thoracic or lumbar sympathetic trunks. The aim is to alter vasomotor control and sweating in the affected area, and the effects are generally permanent.

Indications for sympathektomi are most often severe primary hyperhidrosis, particularly of the palms, and it may be considered for facial or axillary sweating. It has also been used in vasospastic disorders such as Raynaud’s phenomenon, and in the past for other conditions like complex regional pain syndrome or angina, though such uses are limited and controversial.

Techniques used include endoscopic thoracic sympathectomy (ETS), the most common approach for upper-body sweating, which typically involves interruption of the sympathetic chain at levels such as T2–T4. Lumbar sympathectomy targets the lumbar chain for lower-limb issues. Surgical methods may involve resection, coagulation, or clipping of nerves; clipping can be potentially reversible, though reversibility is not always achieved. Chemical or neurolytic sympathectomy with injections is another, less common option.

Risks and outcomes vary by level and indication but can include Horner’s syndrome if cervical or upper thoracic levels are affected, pneumothorax, pleural effusion, nerve injury, infection, and compensatory sweating in other body areas. Many patients experience substantial relief of symptoms, though recurrence or incomplete relief can occur, and the procedure is permanent, necessitating careful patient selection and counselling.

History and context: Sympathektomi has been practiced since the mid-20th century, with modern endoscopic methods established from the 1990s onward. It remains a significant, but selectively used, intervention in the treatment of hyperhidrosis and related conditions.