title: Sympathetic chain clipping for hyperhidrosis is not a reversible procedure.
abstract: BACKGROUND
  Many techniques have been used to treat palmar hyperhidrosis. Compensatory sweating is a difficult adverse effect. Clipping has been proposed because of its supposed reversibility when clips are removed at a later date. The primary aims of this article are to investigate the neuronal lesion of the sympathetic chain caused by clipping and to study the possibility of regeneration after removal of the clips.
  
  
  METHODS
  We performed an experimental study at the Minimally Invasive Surgery Centre Jesus Uson in Caceres (Spain). We used a swine model, performing clipping, unclipping, and extirpation of different segments of sympathetic chain with clips and after clip removal, following a chronogram of 10, 20, and 30 days. Pathologic studies of specimens and statistics were done at the University of Seville.
  
  
  RESULTS
  Ten days after clipping, all sympathetic chains displayed evident Wallerian degeneration. Twenty days after clipping, Wallerian degeneration of myelinated fibers was more widespread and also more striking. Thirty days after clipping, a very marked macrophagic reaction was visible, with multiple signs of phagocytosis of myelin debris. By 30 days post operation and 20 days after clip removal, a few residual myelin and amyelinated fibers were visible. These findings suggest that axon regeneration is not possible.
  
  
  CONCLUSIONS
  There are Wallerian degeneration and axon loss 10 days after clipping. The almost total absence of myelinated and amyelinated fibers following clip removal suggests that there was no nerve regeneration, and that therefore clipping cannot be considered a reversible technique.
authors.affiliation: Department of General and Thoracic Surgery, Virgen Macarena University Hospital, Ave. Dr. Fedriani, 3, 41074, Seville, Spain.
authors.forename: Jesus
authors.initials: J
authors.lastname: Loscertales
authors.forename: Miguel
authors.initials: M
authors.lastname: Congregado
authors.forename: Rafael
authors.initials: R
authors.lastname: Jimenez-Merchan
authors.forename: Gregorio
authors.initials: G
authors.lastname: Gallardo
authors.forename: Ana
authors.initials: A
authors.lastname: Trivino
authors.forename: Sergio
authors.initials: S
authors.lastname: Moreno
authors.forename: Beatriz
authors.initials: B
authors.lastname: Loscertales
authors.forename: Hugo
authors.initials: H
authors.lastname: Galera-Ruiz
mesh_terms: D000818:Animals; D006945:Hyperhidrosis / Q000601:surgery*; D011446:Prospective Studies; D034421:Sus scrofa; D013562:Sympathectomy / Q000379:methods*; D013564:Sympathetic Nervous System / Q000601:surgery; D013906:Thoracoscopy / Q000379:methods*
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