Effectiveness and safety of endoscopic thoracic sympathectomy for excessive sweating and facial blushing: a systematic review.
OBJECTIVE
Despite controversies, endoscopic thoracic sympathectomy (ETS) has been used as a treatment for excessive sweating of hands and face and for facial blushing. This study aims to evaluate the effectiveness of ETS for the current indications in a systematic review.


METHODS
Controlled clinical trials and cohort studies with more than 100 patients were included. Abstracts were searched from MEDLINE and CCTR from 1966 to June 2004. Two reviewers extracted the data and assessed study quality. Data on effectiveness and safety were synthesized qualitatively.


RESULTS
We did not find any controlled clinical trials. Fifteen prospective studies were included. The internal and external quality of these studies were poor overall. Follow-up was commonly less than 2 years, during which time excessive sweating and facial blushing seemed to decrease among most patients. Immediate complications related to thoracoscopy occurred in up to 10 percent of patients. Compensatory sweating below breast level was reported in up to 90 percent of the patients. Other common side effects included dryness of face and hands, gustatory sweating, and neuralgic pain. Several other less common side effects were reported.


CONCLUSIONS
The evidence of the effectiveness of ETS is weak due to a lack of randomized trials. The intervention leads to severe immediate complications in some of the patients, and to persistent side-effects for many of the patients.
Malmivaara
Antti
A
Finnish Office for Health Technology Assessment, and Department of Physiatrics, University of Oulu, Box 8000, 90014 University of Oulu, Finland. antti.malmivaara@stakes.fi
Kuukasjärvi
Pekka
P
Autti-Ramo
Ilona
I
Kovanen
Niina
N
Mäkelä
Marjukka
M
D001821:Blushing; D004724:Endoscopy; D005387:Finland; D006801:Humans; D013546:Sweating; D013562:Sympathectomy / Q000379:methods*; D013900:Thoracic Nerves / Q000601:surgery; D019616:Thoracic Surgical Procedures; D016896:Treatment Outcome