Ann Thorac Surg 2006;81:1047
© 2006 The Society of Thoracic Surgeons
Original article: General thoracic
Invited commentary
Thomas M. Daniel, MD
Division of Thoracic and Cardiovascular Surgery, University of Virginia Health System, Box 800679, 1221 Lee St, Charlottesville, VA 22908-0679
(Email: tmd5m{at}virginia.edu).
Licht and co-authors [1] call attention to the gustatory side effects of thoracoscopic sympathectomy in their retrospective study of 238 patients during an 8-year period. This side effect is described by the authors as postoperative facial sweating when eating certain foods, particularly spicy foods or acidic fruits such as apples or oranges. They observe the incidence of gustatory sweating to be 32% and noted that it was significantly associated with the extent of the sympathectomy. Although it was not the primary focus of the report, the incidence of compensatory sweating (90%) was also discussed as its severity was also associated with the extent of the sympathectomy. It is important to know their indications for the extent of sympathectomy, all of which were bilateral. Facial hyperhidrosis patients underwent T2 sympathectomy, those with palmar hyperhidrosis (ie, T2 to T3), and those with axillary hyperhidrosis (ie, T2 to T4). The reader must be aware of the pitfall of retrospective studies such as this in that they cannot distinguish whether the extent of sympathectomy or the location of primary hyperhidrosis was the primary factor responsible for the gustatory or compensatory sweating. A limitation of this study is also the fact that the median follow-up of patients was only 17 months with a range of 1 to 72 months. It would be informative to know more quantitative information regarding the time from surgery to the onset of symptoms in order to more fully inform our patients as to what to expect with time. Any retrospective study that must deal with subjective symptoms will be easy to dismiss as unscientific. However this report is very important in emphasizing the importance of full preoperative explanation to patients of the inevitable postoperative adaptation of the human body to the removal of a significant body surface area from the necessary thermoregulatory functions of the skin and subcutaneous tissue.
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References
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- Licht PB, Pilegaard HK. Gustatory side effects after thoracoscopic sympathectomy Ann Thorac Surg 2006;81:1043-1047.[Abstract/Free Full Text]
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