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Jun 15, 2015 · Surgery cures rare condition

The article is misleading, and continues with the practice of claiming medical half-truths and assumptions as facts. Not knowing is one thing (and trying to cover it up) but misstating the facts is another level of ‘misleading’, and should not be accepted by peers. The status of the MAYO Clinic is being damaged by these ‘sciency’ medical myths and infomercials on ‘cures’.

The nature of this procedure is knowingly misrepresented by many surgeons and institutions that offer it and profit from performing it.
There is significant difference between stating that “surgery involves severing the sympathetic nerve chain into the hands” and what sympathotomy really does. If it was to disrupt the nerve ‘to the hands’, that would be ramicotomy, and that would leave the chain intact. This has been done (and reported) in the literature.

Sympathotomy, as done at the MAYO Clinic disrupts the ANS. It affects the overall autonomic nervous system (ANS) balance, the SNS – PSNS balance. Or, as the surgeons at MAYO reported in their publication:

“Intraoperative predictability of successful outcome depends on monitoring of the acute response to surgical denervation and abrupt release of sympathetic tone”
Mayo Clin Proc. • May 2005;80(5):657-666

Information on the long-term physiological sequelae is emerging rapidly. Preoperatively, in addition to abnormal sudomotor control, sympathetic cardiovascular regulation may be affected mildly in severe cases of hyperhidrosis. A blunted reflex bradycardia response to parasympathomimetic maneuvers such as Valsalva maneuver or cold water face immersion, as well as an increased heart rate response to orthostatic stress, suggests a hyperfunctioning sympathetic discharge that is reversed after ETS.25,69 Because sympathetic cardiac accelerator fibers exit the spinal cord from segments T1 to T4, ETS is believed to simulate a mild physiological !-adrenergic blockade.7

Mayo Clin Proc. • May 2005;80(5):657-666

Translation of the above means that it will affect the overall sympathetic nervous system and organs, including the heart. Just how severe this effect is is largely unpredictable, but there are reports of young, healthy people needing a pacemaker after T2 sympathectomy.
It will also affect the spinal cord (again just how much and what the effect of this will be is unpredictable):

“synaptic reorganization in the sympathetic chain or spinal cord after sympathotomy” – MAYO Clinic
That means: cell-body reorganization within the spinal cord! Elective surgery affect the spinal cord! – should be the title of the MAYO article… if we want to have informed patients…. Surely, this material if one is contemplating an ELECTIVE procedure?!

The claim from MAYO Clinic is that sympathotomy avoids most of the severe complications, but that assertions can not be backed up by evidence. There is the issue of anatomical variability of the sym. nervous system between individuals, and the issue of heat damage. First, it is close to impossible to see where the ganglia is (contrary to the many illustrations that exist online), so surgeons usually rely on secondary ‘landmarks’ fro example the location of the rib, and many claim to perform T2 sympathotomy simply because they resected, burnt or clamped the chain over the 2nd rib. To this comes the injury caused by the heat from the electrocautery – hardly an exact instrument…

Looking at the literature, the systematic reviews and experience from other centres, it is hard to see how one can reconcile the MAYO Clinic results (and do not forget, they perform this about 10-times a year!) with the many publications that warn against T2 or above disruption of the chain. One of these is the Expert Consensus of the Society of Thoracic Surgeons, published in 2011. In their publication they warn against doing the surgery at level T2 or above. The MAYO Clinic technique is either T2 or above…
The consensus document cites a lot of published studies that claim that the more severe side-effects occurred when this level was disrupted.

This is fake science that does not stand up to scrutiny, is not based on scientific fact/evidence (and often contradicts it). It damages the reputation of the MAYO Clinic.

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