Sympathectomy
Sympathectomy is a surgical procedure aimed at interrupting the sympathetic nerves that control involuntary bodily functions, particularly in cases where these nerves cause inappropriate blood vessel constriction or excessive sweating. It is often indicated for conditions like Raynaud's phenomenon, which leads to painful blood flow issues in extremities during cold exposure, and for excessive sweating or facial blushing. During the procedure, specific nerves are located, and a portion is surgically removed to restore normal vasodilation and improve blood circulation to the affected area.
Sympathectomy can be performed through different techniques, including outpatient procedures using local anesthesia and endoscopic methods, particularly in cases of excessive sweating. While it has a high success rate in alleviating symptoms, potential complications may include changes in blood pressure and the possibility of compensatory sweating in other body areas. Patients typically undergo a preliminary assessment to determine if they will benefit from the surgery. Although less invasive treatments, such as Botulinum toxin injections, have become more popular in recent years, sympathectomy continues to be a relevant treatment option for specific conditions.
Sympathectomy
Anatomy or system affected: Back, neck, nerves, nervous system, spine
Definition: The surgical interruption of part of the sympathetic nerve pathway
Indications and Procedures
The autonomic nervous system controls the involuntary internal environment of the body, and the sympathetic nerves increase energy expenditures by accelerating the heart rate, increasing the metabolic rate, and constricting and dilating blood vessels, among other actions. Occasionally, the proper regulation of vasoconstriction or vasodilation goes awry, and the sympathetic nervous system causes prolonged and inappropriate constriction of the blood vessels to a specific area. In Raynaud’s phenomenon, there is intermittent constricting of blood vessels when the fingers, toes, ears, or nose is exposed to cold. The affected areas change color from white to blue to red, and the condition can be associated with numbness, tingling, burning, and pain. Symptoms of long-term blood-vessel constriction associated with decreased blood flow include cold and clammy skin, areas of gangrene, and painful fibrous growths and infections. In other cases, excessive sweating and facial blushing may be candidates for correction with sympathectomy.
After the specific nerves are located, the patient is prepared for surgery and opened in the location of the nerves to be targeted, typically the neck or back area. Organs are moved or adjusted as needed. The offending region of the nerve is clipped from the remainder and removed. The organs are replaced or repaired, and the incisions are closed. Normal vasculardilation will return rapidly and, with it, warmth to the area and healing of any infections, fibrous tissue, and areas of gangrene.
In the treatment of excessive sweating, often sympathectomy can be performed as an outpatient procedure under local anesthesia. A small incision is made under the armpit, and air is introduced into the chest cavity. The surgeon inserts a fiber-optic tube called an endoscope, which projects an image onto a screen. Lasers are used to destroy the ganglia involved in the excessive sweating.
Uses and Complications
To determine if sympathectomy is an appropriate treatment, the nerve in question is injected with a steroid and anesthetic to block the nerve function temporarily. If the condition in question is relieved, then the patient will likely benefit from sympathectomy. After surgery is completed, Doppler ultrasonography, which uses sound waves to measure blood flow, can be used to determine whether the procedure has succeeded in increasing circulation.
Potential complications include those common to all major surgeries. Depending on the type of sympathectomy performed, side effects may include a decrease in blood pressure when standing, which can lead to fainting spells. About 30 percent of cases of sympathectomy for treatment of excessive sweating result in an increase in sweating of the chest, but the procedure is 90 percent effective in alleviating excessive sweating of the face, hands, and feet. Although alternative and less invasive treatments for excessive sweating, such as Botulinum toxin injections, became more common in the 2020s, sympathectomy remained a viable medical treatment option.
Bibliography
Barrett, Kim E., et al. Ganong's Review of Medical Physiology. 25th ed., McGraw-Hill Education, 2016.
Griffith, H. Winter. Complete Guide to Symptoms, Illness & Surgery. Revised and updated by Stephen Moore and Kenneth Yoder, rev. 6th ed., Perigee, 2012.
Cronenwett, Jack L., and K. Wayne Johnston, editors. Rutherford's Vascular Surgery. 8th ed., Elsevier, 2014. 2 vols.
Stanley, James C., et al., editors. Current Therapy in Vascular and Endovascular Surgery. 5th ed., Elsevier, 2014.
“Sympathectomy.” Johns Hopkins Medicine, www.hopkinsmedicine.org/health/treatment-tests-and-therapies/sympathectomy. Accessed 21 July 2023.