Thoracoscopic Sympathicotomy For Disabling Palmar Hyperhidrosis: A Prospective Randomized Comparison Between Two Levels (original) (raw)
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Background To compare the results obtained with T3 versus T4 sympathectomy in treatment of primary palmar hyperhidrosis(PH). Methods By retrospective review of medical records of patients with PH who underwent thoracoscopic sympathectomy from February, 2009 to September, 2012. The patients were categorized into two groups: T3 group underwent T3 sympathectomy and T4 group underwent T4 sympathectomy. Patients were evaluated according to the results of sweating, compensatory hyperhidrosis (CH), degree of satisfaction, complications and recurrence. Mean follow up was 19+7 months. Results A total of 274 consecutive patients with PH were included in this study. There were 169 females and 105 males, with mean age of 29±11 years. 129 patients underwent T3 sympathectomy (T3 group). The T4 group included 145 patients who underwent T4 sympathectomy. 71.7% patients of T4 group did not complain of CH in comparison to 25.6% patients in group T3 (P=0.001) and the incidence of mild to moderate CH w...
Clinics (São Paulo, Brazil), 2009
To compare two surgical techniques (denervation levels) for sympathectomy using video-assisted thoracoscopy to treat palmar hyperhidrosis in the long-term. From May 2003 to June 2006, 60 patients with palmar hyperhidrosis were prospectively randomized for video-assisted thoracoscopic sympathectomy at the T2 or T3 ganglion level. They were followed for a mean of 20 months and were evaluated regarding their degree of improvement of palmar hyperhidrosis, incidence and severity of compensatory hyperhidrosis and its evolution over time, and quality of life. Fifty-nine cases presented resolution of the palmar hyperhidrosis. One case of therapeutic failure occurred in the T3 group. Most of the patients presented an improvement in palmar hyperhidrosis, without any difference between the groups. Twenty months later, all patients in both groups presented some degree of compensatory hyperhidrosis but with less severity in the T3 group (p = 0.007). Compensatory hyperhidrosis developed in most p...
ENDOSCOPIC THORACIC SYMPATHECTOMY FOR PRIMARY PALMAR HYPERHIDROSIS: INTERMEDIATE TERM RESULTS
Anz Journal of Surgery, 1999
Background Primary hyperhidrosis is a disorder that is characterized by excessive sweating in disproportion to that required for thermoregulation. In most cases, this is aggravated by emotional factors and by heat. Hyperhidrosis can be seen in the palms of the hands, armpits, soles of the feet and face. The principal characteristic of this disease is the intense discomfort of patients, which affects their social and professional life. Treatment modalities include topical application of aluminum chloride, iontophoresis, anticholinergics, botulinum toxin injection, liposuction, excision of sweat glands, and thoracic sympathectomy. Methods Between January 1998 and August 2007, a prospective study of endoscopic thoracic sympathectomies for palmar hyperhidrosis was undertaken based on case histories and a prospective pre-and postoperative questionnaire survey. The sample comprised of 322 patients with a mean age of 24 years. At Apollo Hospital, New Delhi, India, bilateral video-assisted thoracoscopic T3 level sympathectomies were performed in all cases. Results All patients had immediate cessation of palmar hyperhidrosis. The mean postoperative stay was 1.1 days. A questionnaire was completed based on their response to a telephone conversation or e-mail. A paired t test and Wilcoxon test was performed on these data and it showed significant improvement in quality of life. Compensatory sweating was found to be the most troublesome side effect for all patients. It was seen in 63% of the patients. This is similar to other reports of compensatory sweating; however, the figure decreases to 29% if we disregard the percentage of patients who reported only mild compensatory sweating. Conclusion In view of the low morbidity and zero mortality rate of this surgical technique, we recommend it as a method of treatment for palmar hyperhidrosis. Thoracic sympathectomy eliminates palmar hyperhidrosis with minimal recurrence (1% in our series) and produces a high rate of patient satisfaction.
Hyperhidrosis is a disorder of excessive sweat production. It can profoundly affect the quality of life and the functional outcome of the patients with severe impairment of daily activities, social relationships and occupational activities. The purpose of this study was to evaluate the effect of thoracoscopic sympathectomy at the T2-T4 levels on the quality of life and the functional outcome of the patients with palmar hyperhidrosis. This retrospective study includes 75 patients with palmar hyperhidrosis referred to the Razi Hospital from 2007 to 2011 and underwent thoracoscopic sympathectomy at the T2-T4 levels. The Quality of life of the patients was evaluated using the Dermatology Life Quality index(DLQI) and questionnaire form for functional outcome, while the pain of the patients was evaluated using the visual analogue scale (VAS) before and 6 months after operation. Results: The mean age of the patients was 26 years. The number of men was nearly equal to women. After operation...
Analysis of clamping versus cutting of T3 sympathetic nerve for severe palmar hyperhidrosis
The Journal of Thoracic and Cardiovascular Surgery, 2010
Objectives: Endoscopic thoracic sympathectomy can predictably eliminate the disabling symptoms of palmar hyperhidrosis. Debate has ensued over competing techniques, in particular, cutting versus clamping of the sympathetic chain. We subjectively assessed the sweat severity in different areas of the body and evaluated changes in the quality of life in patients undergoing either the cutting or clamping technique. Methods: Patients examined between June 2003 and March 2007 were asked to quantify the severity of their symptoms before and after endoscopic thoracic sympathectomy. The interviews were conducted approximately 1 year after the procedure. Only the patients undergoing sympathectomy at the T3 level for a chief complaint of palmar hyperhidrosis were included in the analysis (n ¼ 152). In 45% of these patients, clamping of the sympathetic chain was performed, and the remaining 55% had the chain cut. Results: After surgery, no patients had continued excessive sweating of the hands. Of all the patients, 95% were satisfied with the results after the cutting procedure and 97% were satisfied after clamping. No difference was seen in any outcome between the patients undergoing clamping versus cutting of the sympathetic chain, including sweating on the hands, face, armpits, feet, trunk, and thighs or in the quality of life. Conclusions: We found high rates of success and patient satisfaction when T3 sympathectomy was performed for palmar hyperhidrosis, with no differences found between the cutting and clamping techniques.
World Journal of Surgery, 2007
Upper dorsal sympathectomy is the only successful therapeutic method for idiopathic palmar hyperhidrosis (IPHH). However, the techniques for sympathetic ablation are still debated. The aim of this study was to compare prospectively two accepted methods for endoscopic sympathetic ablation: resection of T2-T3 ganglia versus transection of the chain over the second to fourth ribs. During the period September 2000 to June 2002, a total of 32 patients with IPHH were operated on. Operations were performed under general anesthesia through two 5-mm trocars using electrocautery. Resection was done on one side and transection on the other, with both sides being addressed during the same operation. The sides of resection/transection were alternated at each operation. There were 14 men and 18 women aged 18.8 +/- 4.7 years. The mean operating times for sympathectomy were 12.0 +/- 3.1 minutes for resection and 6.6 +/- 1.9 minutes for transection (p = 1.38). All patients were examined at 2 weeks postoperatively and again at 1 month. During November-December 2005, patients were approached by telephone questionnaire, the mean follow-up period being 4.3 +/- 0.9 years. Altogether, 26 of the 32 patients could be located (15 women, 11 men). There was no significant difference with regards to perioperative complications, immediate or long-term pain. All but two hands were warm and dry 1 month after operation and remained so at follow-up. The exceptions included one hand with recurrent hyperhidrosis after 1.5 years and one that became less dry and cold at 3 years. Both were on the transected sides. Our results suggest that sympathetic resection may achieve slightly better long-term results than transection in patients with IPHH. Large-scale prospective studies are needed to confirm these results.
Interactive cardiovascular and thoracic surgery, 2013
Video-assisted thoracoscopic sympathectomy is currently the best treatment for palmar and axillary hyperhidrosis. It can be performed through either one or two stages of surgery. This study aimed to evaluate the operative and postoperative results of two-stage unilateral vs one-stage bilateral thoracoscopic sympathectomy. From November 1995 to February 2011, 270 patients with severe palmar and/or axillary hyperhidrosis were recruited for this study. One hundred and thirty patients received one-stage bilateral, single-port video-assisted thoracoscopic sympathectomy (one-stage group) and 140, two-stage unilateral, single-port video-assisted thoracoscopic sympathectomy, with a mean time interval of 4 months between the procedures (two-stage group). The mean postoperative follow-up period was 12.5 (range: 1-24 months). After surgery, hands and axillae of all patients were dry and warm. Sixteen (12%) patients of the one-stage group and 15 (11%) of the two-stage group suffered from mild/m...
Annals of Pediatric Surgery, 2020
Background Hyperhidrosis is an excess sweat secretion. Various modalities of treatment exist for hyperhidrosis. Although medical treatment is the first line of treatment, its long-term outcome is not satisfactory. In this study, we compared the results of thoracoscopic excision with that of radiofrequency ablation of the sympathetic chain as a treatment of palmar hyperhidrosis. Results During the period from January 2014 to December 2017, 42 patients with palmar hyperhidrosis after failure of medical treatment presented to Departments of Pediatric Surgery and Neurosurgery, Faculty of Medicine. They were 26 males and 16 females. Their ages ranged between 11 and 42 years (mean 21.78 years). Twenty patients underwent thoracoscopic excision of the sympathetic chain (in Pediatric Surgery Department), while 22 patients underwent radiofrequency ablation of the sympathetic chain (in Neurosurgery Department). For the thoracoscopic sympathectomy group, the mean operative time was 27.39 min, t...
Arquivos de Neuro-Psiquiatria, 2012
OBJECTIVE: Surgery for both palmar and axillar hyperhidrosis usually includes the interruption of the sympathetic chain in multiple levels. This study aimed to determine the long-term outcomes associated to video-assisted thoracic sympathotomy (VATS) of T2, T3 and T4 ganglia for these cases. METHODS: Analysis of the outcomes obtained from 36 patients regarding the rate of resolution of the symptoms and the compensatory sweating (CS). All subjects were followed-up for 36 months. RESULTS: Good outcomes were observed in 98.6% for palmar and 60% for axillary hyperhidrosis (p=0.0423), respectively. Of the subjects, 86% reported some postoperative episode of CS, however only 45% (p=0.0031) still noticed it at the end of the follow-up period. CONCLUSIONS: VATS is effective for the excessive palmar sweating, whereas it is fully efficient for only two thirds of the cases sustaining associated axillar hyperhidrosis. CS is expected as a rule following the proposed operative protocol, however i...