title: Excision of sympathetic ganglia and the rami communicantes with histological confirmation offers better early and late outcomes in Video assisted thoracoscopic sympathectomy.
abstract: BACKGROUND
  Video-Assisted Thoracoscopic Sympathectomy (VATS) is an established minimally invasive procedure for thoracic sympathetic blockade in patients with hyperhidrosis, facial flushing and intractable angina. Various techniques using clips, diathermy and excision are used to perform sympathectomy. We present our technique of excision of the sympathetic chain with histological proof and the analysis of the early and late outcomes.
  
  
  METHODS
  We evaluated 200 procedures in 100 consecutive patients, who underwent Video Assisted Thoracoscopic Sympathectomy by a single surgeon in our centre between September 1996 to March 2007. All patients had maximum medical therapy prior to surgery and were divided into 3 groups based on indications, Group 1(hyperhidrosis: 48 patients), Group 2 (facial flushing: 26 patients) and Group 3(intractable angina: 26 patients). The demography and severity of symptoms for each group were analysed. The endpoints were success rate, 30 day mortality, complications and patient's satisfaction.
  
  
  RESULTS
  99 patients had bilateral VATS sympathectomy and 1 had unilateral sympathectomy. The conversion rate to open was 1(1%). All patients had successful removal of ganglia proven histologically with no perioperative mortality in our series. The complications included pneumothorax (5%), acute coronary syndrome (2%), transient Horner's syndrome (1%), transient paraesthesia (1%), wound infection (4%), compensatory hyperhidrosis (18%), residual flushing (3%) and wound pain (5%). There were five late deaths in the intractable angina group at a mean follow up of 36.7 months. Overall success rates of abolishing the symptoms were 96.3%, 87.5% and 95.2% for Group 1, 2 and 3 respectively.
  
  
  CONCLUSIONS
  Excision of the sympathetic chain with histological confirmation during VATS sympathectomy is a safe and effective method in treating hyperhidrosis, facial flushing and intractable angina with good long term results and satisfaction.
authors.affiliation: Regional Department of Thoracic Surgery, Birmingham Heartlands Hospital, Bordesley Green East, Birmingham, B9 5SS, UK. srathinam@rcsed.ac.uk
authors.forename: Sridhar
authors.initials: S
authors.lastname: Rathinam
authors.forename: Prakash
authors.initials: P
authors.lastname: Nanjaiah
authors.forename: Sivakumar
authors.initials: S
authors.lastname: Sivalingam
authors.forename: Pala B
authors.initials: PB
authors.lastname: Rajesh
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000787:Angina Pectoris / Q000601:surgery; D005260:Female; D005483:Flushing / Q000601:surgery; D005500:Follow-Up Studies; D005728:Ganglia, Sympathetic / Q000473:pathology* / Q000601:surgery*; D015171:Ganglionectomy / Q000379:methods*; D006801:Humans; D006945:Hyperhidrosis / Q000601:surgery; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020775:Thoracic Surgery, Video-Assisted / Q000379:methods*; D013904:Thoracic Vertebrae; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult