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Is Sympathetic Chain Clipping for Hyperhidrosis a Reversible Procedure?

I read with great interest the recent article by Findikcioglu et al,1who compared clipping and ablation of the sympathetic chain in patients with primary palmar hyperhidrosis. I would like to thank the authors for their valuable contribution. However, there are some issues to be clarified about their research. In their study,1 the authors could not demonstrate superiority of clipping to cauterization of sympathetic chain. They stated that theoretically, clipping the sympathetic chain had the potential for reversibility by removing the clips. They removed the clips in three of their patients because of severe compensatory sweating. Although they observed that the removal of clips were unsuccessful in controlling the side effects, they suggested that the clipping technique was potentially reversible. I agree with most of their comments about the sympathectomy, but I cannot agree with the potential reversibility of the clipping technique. FromApril 2010 until November 2011, clipswere removed in nine of our patients whose sympathetic chain was previously clipped in our clinic due to palmar hyperhidrosis. All of our patients requested reversal because of severe compensatory sweating. In addition, one of our patients had overdrying of the hands and one had gustatory sweating. All of the patients were men, and their mean age was 21.6 (range, 20 to 28 years old). After removal of the clips, themean follow-up time was 44.1 months (range, 32 to 49 months). None of the patients reported complete resolution of their symptoms, and removal of the clips provided only partial relief in one case. In conclusion, in light of our experiences, removal of the clips is an unsuccessful procedure in treatment of compensatory sweating. In the literature, few articles exist regarding the advantages of clip removal after the sympathetic chain was clipped due to palmar hyperhidrosis. Our data did not show easy reversibility of the clipping technique. However, randomized controlled trials are needed to confirm our results.