Authors' objectives:

Endoscopic thoracic sympathectomy aims to reduce excessive sweating in face and hands and flushing of the face due to a disproportionate function of the sympathetic nervous system. The treatment is provided as an endoscopic procedure, where the upper thoracic chain of the sympathetic nerve trunk is transsected or clamped. In Finland this treatment has also been used for social phobia.

The aim of this report was to assess by a systematic review the effectiveness and safety of endoscopic thoracic sympathectomy for these particular indications.

Authors' results and conclusions: Due to poor reporting of patient characteristics and differences in the reporting of outcomes, it is difficult to do even a qualitative synthesis of the studies. In addition, the methodological quality of most of the studies was poor. However, it seems that excessive sweating of hands and flushing of face are less after the operation. Patient satisfaction was reported as good or moderately good. Unfortunately, only in one study were all the patients followed up for more than two years. In two Finnish studies, social phobia was the indication for endoscopic thoracic sympathectomy. Treatment satisfaction according to Davies social phobia scale after the treatment was 3.5 on a scale of 1 to 5. The reporting of immediate complications due to endoscopic thoracic sympathectomy showed wide variation: up to 10 percent of patients, with some severe complications. The most common of the long-lasting or persistent complications was compensatory sweating below the breast level. This symptom may cause signifi cant disability for the patients. Among other long-lasting complications there was dryness of skin in the face or hands and gustatory sweating while eating. Due to wide variation in the reporting of complications, it is probable that these have been underreported most of the time.

Authors' recommendations: In conclusion, due to lack of controlled trials there is no reliable evidence for the effectiveness of endoscopic thoracic sympathectomy for excessive sweating in the face and hands or for flushing of the face. Neither is there any evidence that this treatment has an impact on social phobia. Endoscopic thoracic sympathectomy is associated with significant immediate and long-term adverse effects.

Authors' methods: Systematic review

Project Status: Completed

URL for project: http://finohta.stakes.fi/NR/rdonlyres/A4F5CFC3-A6B4-43F5-8E2A-49689F3B7980/0/r026f.pdf

Year Published: 2005

English language abstract: An English language summary is available

Publication Type: Not Assigned

Country: Finland

Organisation Name: Finnish Coordinating Center for Health Technology Assessment

Contact Address: Finnish Office for Health Care Technology Assessment (Finohta)

Contact Name: .

Contact Email: fincchta@ppshp.fi

Copyright: Finnish Office for Health Care Technology Assessment