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J Thorac Cardiovasc Surg 2009;137:1376-1377
© 2009 The American Association for Thoracic Surgery

Invited Commentary

Discussion

Dr James Allan (Boston, Mass). Thanks very much. That was very nicely presented and I want to congratulate you on adding a large body of data to the literature.

I find the data provocative in several respects. First, in your series, 25 patients (3.4%) underwent repeat surgery due to a lack of effectiveness of the initial operation. The majority of these patients had initially been clipped at just the T2 level for palmar hyperhidrosis. In my personal experience of about 60 patients, I have never needed to reoperate on a patient; however, I perform a T2 to T4 ablation with division of accessory nerves, not just a T2 clipping. So I would like to know whether the initial failure in these patients reflects (1) that clipping at a given level may be inferior in efficacy to cutting or ablating at the same level, (2) that some patients simply require longer sympathectomies than others in an unpredictable fashion, or (3) that the initial failures are a reflection of performing a procedure that does not address accessory sympathetic fibers?

Dr Sugimura. Dr Allan, thank you very much for your comments and questions.

It is true that we had 25 redo surgeries that required redo because of suboptimal results or what looked like early recurrence of their symptoms, and the majority were in patients that received T2 clipping for palmar hyperhidrosis.

In regards to the difference between the clipping method and the cutting or ablation method, I think that our results using the clipping method are comparative to the results utilizing other methods in terms of satisfaction or treatment success. Some authors with experience with both methods even suggest that clipping was more effective. . . . [Full Text of this Article]