Sympathectomie thoracique

Upper thoracic sympathectomies, performed most of the time by coelioscopy, have become mildly aggressive interventions. Such procedure is primarily indicated for palmar and axillary hyperhidroses; it is also indicated in case of collagenosis-related disabling syndromes of Raynaud's disease, causalgias, distal arterial occlusions with thrombotic or embolic digital lesions, and lesions due to Buerger's disease. Thoracotomy is considered only in case of thoracoscopy failure or infeasibility. Other accesses are far less utilized. Ablation of the 2nd and 3rd thoracic sympathetic ganglia is sufficient for hand lesions; in case of axillary hyperhidrosis, further exeresis of the 4th and 5th ganglia is necessary. The only disadvantage related to this indication is the frequent postoperative compensatory hypersudation that involves both the thorax and the lumbar area, but which doesn't constitute a real complaint for the patients.