Endoscopic thoracic sympathectomy for hyperhidrosis: Technique and results (original) (raw)
Related papers
Hospital Practices and Research, 2016
Background: Primary hyperhidrosis (PH) refers to excessive sweating, beyond normal physiological levels, in specific sites of the body for unknown reasons. It is usually bilateral and is most prominent in the palms, axillae, feet, and face. PH prevalence is estimated to be 0%-6.1% in different populations. It usually begins in childhood and is more frequent in women. In 57% of cases, there is a positive family history. It is an autosomal dominant disorder with variable penetration in chromosomes 5, 14, or both. Objective: The aim of this study was to illustrate current treatments of PH while focusing on surgical therapies through a narrative review. Methods: A complete search of online articles from 2007 to 2014 in PubMed, Scopus, and the Cochrane Library was performed. A free search and a search in the MeSH database for the study's keywords were also done. More than 600 relevant articles were found, of which 51 were chosen for this study. This article is based on those articles. Results: Surgery is the best and more permanent therapy for PH. The most common consequences of surgery are compensatory sweating and gustatory sweating. There is controversy concerning whether lowering the level and limiting the number of ganglia on which surgery is performed reduces compensatory sweating. Conclusion: It seems that ramicotomy (selective division of the sympathetic postganglionic fibers) reduces compensatory sweating, but this theory should be confirmed with more studies.
Hyperhidrosis: A Review of a Medical Condition
The Open Dermatology Journal, 2009
Sweating is a normal and important mechanism of thermoregulation which is essential for survival. When sweating becomes excessive, the resulting condition is called hyperhidrosis. While hyperhidrosis is not a fatal condition, it can greatly affect one's quality of life due to its psychological and social impact. To understand this condition, it is necessary to explore the biology of sweat glands including the eccrine, apocrine, and apoeccrine sweat glands. It is also vital to understand the physiological significance of sweat to maintain the human body temperature in order for it to function properly. Hyperhidrosis can be divided into a primary and secondary condition and it is also associated with a wide variety of other conditions. Many treatments exist to alleviate this disorder including aluminum compounds, aldehydes, anticholinergic agents like glycopyrrolate, benztropine and oxybutynin, botulinum toxin A, antiperspirants, sympathectomy, iontophoresis, and sweat gland suction. Ultimately, knowledge of this disorder and its methods of treatment and management are imperative to optimize treatment for patients suffering from hyperhidrosis.
Pathophysiology of hyperhidrosis
Shanghai Chest
Introduction: hyperhidrosis Primary or essential hyperhidrosis is a pathological disorder of unknown etiology, characterized by excessive and chronic perspiration that exceeds the physiological needs for a normal thermoregulation (1). In fact, it is an exaggerated response to physiological stress or emotional/psychological stimulus. Primary hyperhidrosis affects 0.6-5% of the world population and affects men and women equally (2). The onset of symptoms usually occurs before the age of 25 (3). Excessive sweat is localized and the anatomical regions mostly affected are palms, axillae, craniofacial region and soles of feet (2,4). An important aspect of primary hyperhidrosis is the occurrence of sweating episodes only when patients are awake (5) regardless of the environmental temperature. Secondary hyperhidrosis is a generalized sweating disorder typically affecting the entire body, as a consequence of another underlying disorder, either metabolic, neoplastic, infectious or endocrine condition (4). Excessive perspiration can occur when patients are awake or sleeping and the onset of symptoms are usually in adulthood, coinciding with the onset of the underlying disorder in question (5). In addition, secondary hyperhidrosis can also be pharmacologically induced, with certain antidepressant medications (3,5). Diagnosis is mainly clinical, with a thorough history and physical examination. Patient history should address disease onset, family history, pattern, triggers, severity and other associated symptoms (6). Hyperhidrosis Disease Severity Scale is an important tool in assessing the impact of disease in patients' daily activities. One such a scale by Strutton and colleagues, based on a US national survey, classifies sweating in 4 categories: never noticeable and never interfering with daily activities, tolerable but sometimes interfering, barely tolerable and frequently interfering, and intolerable and always interfering (6). A score of 3 or 4 indicates serious hyperhidrosis, which requires treatment. Hyperhidrosis can be diagnosed with a minor starch-iodine test, which is a semiquantitative test that can be used for whole-body mapping (1,3). There are no standardized definitions or quantitative measures that exist for diagnostic purposes. For research
Videosurgery and Other Miniinvasive Techniques, 2012
Introduction: Hyperhidrosis is excessive sweating beyond the needs of thermoregulation. It is disease which mostly affects young people, often carrying a considerable amount of socioeconomic implications. Thoracic sympathectomy is now considered to be the "gold standard" in the treatment of idiopathic hyperhidrosis of hands and armpits. Aim: Assessment of early effectiveness of thoracic sympathectomy using skin resistance measurements performed before surgery and in the postoperative period. Material and methods: A group of 20 patients with idiopathic excessive sweating of hands and the armpit was enrolled in the study. Patients underwent two-stage thoracic sympathectomy with resection of Th2-Th4 ganglions. The skin resistance measurements were made at six previously designated points on the day of surgery and the first day after the operation. Results: In all operated patients we obtained complete remission of symptoms on the first day after the surgery. Inhibition of sweating was confirmed using the standard starch iodine (Minor) test. At all measurement points we obtained a statistically significant increase of skin resistance, assuming p < 0.05. To check whether there is a statistically significant difference in the results before and after surgery we used sequence pairs Wilcoxon test. Conclusions: Thoracic sympathectomy is an effective curative treatment for primary hyperhidrosis of hands and armpits. Statistically significant increase of skin resistance in all cases is a good method of assessing the effectiveness of the above surgery in the early postoperative period.
Recognition, diagnosis, and treatment of primary focal hyperhidrosis
2000
P rimary focal hyperhidrosis is a disorder of excessive, bilateral, and relatively symmetric sweating occurring in the axillae, palms, soles, or craniofacial region. The condition results in occupational, psychological, and physical impairment, and potential social stigmatization.
Localized unilateral hyperhidrosis
British Journal of Dermatology, 1987
A case of unilateral hyperhidrosis of the face is described. Measurements of the rate of evaporative water loss from other areas ofthe body, showed a marked left-right difference in the sweating rate on the arms and on the legs which had not been suspected clinically.
Interactive cardiovascular and thoracic surgery, 2013
Patients diagnosed with axillary hyperhidrosis can face psychosocial issues that can ultimately hinder their quality of life both privately and socially. The routine treatment for axillary hyperhidrosis is T3-T4 sympathectomy, but compensatory sweating is a serious side effect that is commonly seen with this approach. This study was designed to evaluate whether a T3 sympathectomy was effective for the treatment of axillary hyperhidrosis and whether this treatment led to less compensatory sweating than T3-T4 sympathectomies among our 60-patient population. One hundred and twenty endoscopic thoracic sympathectomies were performed on 60 patients who had axillary hyperhidrosis. The sympathectomies were accomplished by means of a single-lumen endotracheal tube and a single port. The axillary hyperhidrosis patients were randomly divided into two groups with 17 patients in Group 1 undergoing T3-T4 sympathectomies and 43 in Group 2 undergoing only T3 sympathectomies. We analysed the data as...