Endoscopic Thoracic sympathectomy for Primary Palmar hyperhidrosis (original) (raw)
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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.
Eurasian Journal of Pulmonology
INTRODUCTION Excessive sweating that is essential for thermoregulation is called hyperhidrosis. When primary hyperhidrosis is seen at face, palm, axillary region, and feet, secondary hyperhidrosis can be seen at any body region. The etiologic factors are obesity, infections, endocrinological disorders, and malignancies (1). Endoscopic thoracic sympathectomy (ETS) should not be performed before the investigation of secondary etiologic factors. Nowadays, ETS is the method of choice for the treatment of palmar and axillary hyperhidrosis. The most commonly seen complication following ETS is the development of compensatory hyperhidrosis at various body regions (2). In this study, we aimed to present technique and duration of operation, pre-and postoperative complications, and the results of long-term outcomes with palmar and axillary hyperhidrosis patients who underwent ETS. METHODS Forty ETS operations, which were applied to 20 patients (11 men and 9 women with a mean age of 25.4 [17-34] years) between April 2014 and July 2014, were evaluated retrospectively. All patients
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...
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.
Endoscopic thoracic sympathectomy for primary palmar hyperidrosis
Surgical Endoscopy and Other Interventional Techniques, 2010
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.
The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis
The Annals of Thoracic Surgery, 2011
Significant controversies surround the optimal treatment of primary hyperhidrosis of the hands, axillae, feet, and face. The world's literature on hyperhidrosis from 1991 to 2009 was obtained through PubMed. There were 1,097 published articles, of which 102 were clinical trials. Twelve were randomized clinical trials and 90 were nonrandomized comparative studies. After review and discussion by task force members of The Society of Thoracic Surgeons' General Thoracic Workforce, expert consensus was reached from which specific treatment strategies are suggested. These studies suggest that primary hyperhidrosis of the extremities, axillae or face is best treated by endoscopic thoracic sympathectomy (ETS). Interruption of the sympathetic chain can be achieved either by electrocautery or clipping. An international nomenclature should be adopted that refers to the rib levels (R) instead of the vertebral level at which the nerve is interrupted, and how the chain is interrupted, along with systematic pre and postoperative assessments of sweating pattern, intensity and quality-of-life. The recent body of literature suggests that the highest success rates occur when interruption is performed at the top of R3 or the top of R4 for palmar-only hyperhidrosis. R4 may offer a lower incidence of compensatory hyperhidrosis but moister hands. For palmar and axillary, palmar, axillary and pedal and for axillary-only hyperhidrosis interruptions at R4 and R5 are recommended. The top of R3 is best for craniofacial hyperhidrosis.
T4 sympathectomy for palmar hyperhidrosis: looking for the right operation
Surgery, 2008
Most surgeons still perform T2 or T2–3 sympathectomy for palmar hyperhidrosis (PH), but both of these treatments can cause severe side effects. Some recent articles advocating T4 sympathectomy have obtained satisfactory results. The aim of this study was to compare the outcomes of 3 different levels of sympathectomy. Between July 2003 and July 2006, we treated 60 patients (20 men and 40 women, mean age 26 years) who suffer from palmar hyperhidrosis by endoscopic thoracic sympathectomy (ETS). Patients were divided into 3 groups according to the level of sympathectomy: ETS2, ETS3, and ETS4 (20 patients in each group). Data were collected by review of medical charts, outpatient clinic notes, and telephone interviews. Patients were asked whether they considered their symptoms to be “cured” or “unchanged.” The degree of hand dryness was assessed subjectively. Postoperative complications (wound infection, chest pain, and Horner's syndrome) were assessed. Any occurrence of gustatory sweating, rhinitis, presence and region of reflex compensatory sweating, and recurrence was noted. Patient satisfaction was assessed. Treatment success at follow-up was 90% for the ETS2, 95% for ETS3 patients, and 100% for the ETS4 patients. In the ETS2 and ETS3 groups, a higher rate of overdryness of limbs was observed (35% and 20%, respectively). The compensatory sweating was mild in the ETS4 group, whereas moderate-to-severe reflex sweating was more common in the ETS2 and ETS3 groups. About 40% of ETS2 groups and 25% of ETS3 group patients were unsatisfied with their operation. All patients of the ETS4 group were satisfied with the outcome. In conclusion, ETS4 sympathectomy is an effective method for treating PH and it decreases the rate of compensatory hydrosis (CH).
Long-Term Results of Thoracoscopic Sympathectomy for Hyperhidrosis
The Annals of Thoracic Surgery, 2004
Background. Thoracoscopic sympathectomy is now the reference treatment for severe palmar hyperhidrosis, but this is offset by the occurrence of compensatory sweating. It has been studied in this series to improve the indications and information given to patients.