COMPLICATIONS OF ENDOSCOPIC THORACIC SYMPATHECTOMY

Background. Endoscopic resection of the thoracic sympathetic trunk has been performed in various diseases of the upper limb. The success rat es in endoscopic techniques and open surgical procedures are reportedl y between 95% and 100%. However, the incidence of complications varied significantly depending on the technique used. We report our experien ce with complications after endoscopic resection of the thoracic sympa thetic trunk. Methods. To evaluate the complications ofendoscopic thor acic sympathectomy, we retrospectively investigated 412 patients opera ted on since 1965. In 412 patients 698 procedures had been performed: a bilateral trunk resection in 81.9%, right thoracic sympathectomy in 12.9%, and left sympathetic trunk resection in 5:2%. Results. Complica tions demanding intervention were found in 2.7% of the procedures, and in 9.7% complications not indicating active therapy were seen. In all cases requiring intervention a pneumothorax that needed to be drained was found on postoperative x-ray film. An asymptomatic small apical p neumothorax was found in 4.4%, cutaneous emphysema in 2%, pleural effu sion in 1.1%, and segmental atelectasis in 0.4% of the procedures. One case of bleeding from an intercostal vessel occurred (0.1%). A perman ent Honer's ptosis was seen in 1.7% of the patients. Conclusions. The endoscopic resection of the thoracic sympathetic trunk is a safe and m inimally invasive procedure with a low complication rate. We believe t hat endosopic sympathectomy should be preferred to open surgical proce dures.