The level of ganglion clipping for hyperhidrosis

Abstract

Sirs: We read with interest the article by Chou et al. ‘‘The outcome of ganglion clipping in hyperhidrosis and blushing’’, published in CAR 16:240–2, 2006 [1]. The authors reported the results of their method of sympathetic ablation performed (apparently bilaterally) in 114 patients. During the follow-up period, they noticed five unilateral recurrences. On chest roentgenographs, they found that, apparently on the side of the failed procedure, they had placed the clips one ganglion lower than the intended level. These results prove that, sometimes during operations, surgeons do incorrectly estimate the levels of sympathetic ablation. Unfortunately, to prove that such mistake is the cause of failure, a routine chest X-ray should be performed in all cases and show that such a mistake occurred only in those that failed. It appears that this was not done by the authors. We therefore do not know in how many other cases in their present series, in which the operation did not fail, the ablation was performed at an unintended level. Without this information, one cannot claim that performing the operation on the intended level assures success.