Endoscopic thoracic sympathectomy in the treatment of severe Raynaud's disease

ABSTRACT

To evaluate the results of endoscopic thoracic sympathectomy in severe cases of Raynaud's disease after medical treatment failure, with particular reference to the complications, safety and the effectiveness. We performed 22 endoscopic thoracic sympathectomies in 16 patients [12 males and 4 females] with severe Raynaud's disease after medical treatment failure. Their ages varies between 23 to 41 years. 10 patients underwent a unilateral endoscopic thoracic sympathectomy procedures, whereas 6 patients with bilateral symptoms underwent staged endoscopic thoracic procedures several weeks a part. Of the total 22 affected hands 4 [18.18%] had severe intractable hand pain; 10 [45.45%] had trophic ulcers associated with terminal digital necrosis and 8 [36.36%] had gangrene of finger tips. All patients were evaluated clinically by history taking and physical examination as well as routine laboratory and radiological screening tests. All patients were carefully counseled on the potential complications of the procedure. We performed 22 endoscopic thoracic sympathectomy procedures [10 unilateral and 6 bilateral]. The mean post operative hospital stay was 1 day. The post-operative follow up ranged between 3 and 12 months with a mean of 6 months as regard to pain relief, healing of ulcers and spontaneous separation of gangrenous parts. There was no mortality and no serious morbidity detected in this study. The 4 hands [18.18%] with severe intractable hand pain were improved completely. Of the 10 hands [45.45%] with trophic ulcers associated with terminal digital necrosis, complete healing of ulcers as well as trophic lesions occurred in 8 of them [36.36%] while no healing detected in the remaining 2 hands [9%]. Of the 8 hands [36.36%] with gangrene of finger tips complete improvement of lesions and clear demarcation of the gangrenous parts occurred in 6 hands [27.27%] and the remaining 2 hands [9%] required later amputation at one or more distal inter-phalyngeal joint. Horner's syndrome occurred in 2 patients [12.5%] resolved in the first patient at 4 weeks and in the second patient at 4 months. Intercostal neuralgia detected in 2 patients. In one of them it appeared immediately after the operation, but in the 2nd it appeared 3 weeks later. The postoperative chest radiograms showed only a slight residual pneumothorax in one patient [6.25%] and non in the remaining cases. Endoscopic thoracic sympathectomy is safe-easy, reliable and effective way in the treatment of patients with severe Raynaud's disease after medical treatment failure