Secondary sympathetic chain reconstruction after endoscopic thoracic sympathicotomy.

Thoracoscopic sympathicotomy by electrocautery is an irreversible procedure. Thus the indications must be meticulously considered before the final decision to operate is taken by both the surgeon and the patient. All possible side effects should be dealt with and written informed consent required. A case of an open nerve reconstruction of the divided sympathetic chains is presented. One year after the reconstruction the patient reported subjective relief of the compensatory oversweating and restoration of sweating in the face and the armpit. Reversible methods like clipping the sympathetic chain should be considered whenever feasible instead of the irreversible electrocoagulation of the sympathetic chain.