Endoscopic thoracic sympathectomy by clamping in the treatment of social phobia : the Monza experience

Aim. Facial blushing represents the peculiar symptom in social phobia and is defined as the "hallmark of embarrassment". At present, endoscopic thoracic sympathectomy (ETS) is the technique only able to guarantee long-term results in the treatment of sympathetic disorders. The aim of our study was to evaluate results, complications and the true value of 52 ETSs by two-port approach with the use of endoclips in patients with isolated facial blushing or in association with hyperhidrosis. Methods. A retrospective review of 52 subjects who underwent standard ETS by clamping between September 2002 and April 2005 was carried out. This surgical practice was performed in 26 cases (50%) for isolated facial blushing only and in other 26 cases (50%) for facial blushing associated to hyperhidrosis with changeable localizations. Under endoscopic guidance we operated an endoscopic sympathetic Mock (ESB)wth interruption of the intergangliar trunk at the level of T2-T3 in 51 patients (98.07%). In 1 patient (1.92%) we performed a sympathetic block with the complete exclusion ofT3 thoracic ganglion. Results. There were no intra and postoperative deaths. The effect rate was excellent in all patients with early complications in one patient (1.92%) only. Conclusions. ETS by clamping is safe and effective. Patients referred an high satisfaction in terms of complications and quality of life; specific early and late diseases are neglectables.