Drawbacks of endoscopic thoracic sympathectomy.

BACKGROUND: Endoscopic thoracic sympathectomy (ETS) has come into widespread use for palmar hyperhidrosis and other complaints of the upper limb and of the head and neck, but there are concerns about its safety. This review highlights the operative complications and long-term side-effects that may occur. METHODS: A Medline search was carried out using the terms 'thoracoscopic sympathectomy', 'endoscopic thoracic sympathectomy' and 'complications'. References from identified articles were handsearched for further relevant articles. The senior author's experience and personal communications were also taken into account. RESULTS AND CONCLUSION: No death following ETS has ever been reported in the literature, but nine anecdotal fatalities are known, five resulting from major intrathoracic bleeding and three from anaesthetic mishap. Significant intrathoracic bleeding may occur in up to 5 per cent of patients but only a minority require thoracotomy; pneumothorax occurs in 2 per cent of patients and two instances of brain damage are known. In the longer term compensatory hyperhidrosis is extremely common and 1-2 per cent of patients regret having had surgery because of its severity. Horner's syndrome, on the other hand, is rare. Improvements in instrumentation, adequate training and careful patient selection may help reduce the drawbacks of ETS.

Life threatening iatrogenic major vascular injuries complicating groin hernia repair.

Major vascular injuries complicating groin hernia repairs are very rare. Five such cases seen at the vascular unit of the Department of Surgery, UNTH, Enugu, Nigeria over a five year period are presented. The patients all of whom were adults (age range 49-65) had initial problems of hypovolaemia due to massive blood loss followed by infection and anaemia. One of the patients died from irreversible shock while still in the Casualty Unit. The vascular injuries were dealt with by either primary repair, vein graft or dacron graft depending on the prevailing conditions e.g. presence or absence of infection. The other 4 patients who had surgery did well postoperatively and on 5 to 58 months follow-up. Emphasis is laid on the underlying causes of these iatrogenic injuries which include inexperience on the part of the operator and inadequate anaesthesia (often wrongly applied local anaesthesia). If this complication however occurs, the wound should be tightly packed and patient sent immediately to a unit with vascular surgical facilities.