Past, present and future of the surgery of the sympathetics.

Surgery of the autonomic nervous system has been used during more than a hundred years for different indications. The trend is in both parasympathetic and sympathetic surgery towards less invasive and more reversible methods. Thus in gastroenterology the bactericides have displaced vagotomies, and in sweating and blushing more and more sophisticated and atraumatic methods have emerged to displace sympathectomies. Even vagal stimulation has come forward to compete with sympathetic ablations in some indications, like depression. The side effects, and especially the late manifestation of some side effects have also raised ethical discussions of the justification of this kind of life quality or life style surgery. In this review, different indications and methods are discussed in the light of future needs and ethical demands.