Is the Clipping Method for Sympathetic Nerve Surgery a Reversible Procedure?

Abstract

Sympathetic nerve surgery is an effective hyperhidrosis treatment, but there is still an average incidence of compensatory sweating (CS) of 60%, regardless of the surgical technique used.

Currently, the gold standard technique is sympatheticotomy, but clipping or neuroprension of the sympathetic chain is gaining traction because of its potential “reversibility”, which ranges from 0% to 100% depending on the series, without hyperhidrosis reappearance. In all clinical studies, except one where reversibility was demonstrated by sudometry, evaluation of the reflex sweat has been subjective; but there is a growing core of experimental studies that show regenerative activity of a nerve validated with immunohistochemical and histologic axonal regeneration techniques.

Even though unclipping is a promising technique, future studies will need to clarify the maximum “reversible” clipping period and maximum compression degree of the nerve before reaching permanent damage. Finally, neurophysiological conduction studies should corroborate that the histological reversibility translates into nerve conduction restoration.