Optimal Level Of Sympathectomy For Primary Palmar Hyperhidrosis;T3 Versus T4 in a Retrospective Cohort Study (original) (raw)
Related papers
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...
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.
European Journal of Cardio-Thoracic Surgery, 2008
Background: Thoracic sympathectomy (TS) is the treatment of choice for severe primary hyperhidrosis. However, complications, side effects and satisfaction have not been well defined. Objective: To analyze the complications, side effects, satisfaction degree and quality of life of patients after TS for primary upper limb hyperhidrosis. Methods: One-year follow-up after 406 consecutive TS for primary upper limb hyperhidrosis. Results: Bilateral TS was completed in all patients. Complications arose in 23 cases (5.6%), with pneumothorax being the most frequent. The success rate after discharge, 6 and 12 months was respectively, 100%, 98.1% and 96.5% for palmo-axillary hyperhidrosis; 100%, 99.3% and 97.8% for isolated palmar hyperhidrosis and 100%, 85.7% and 71.4% for isolated axillary hyperhidrosis. No persistence of hyperhidrosis was observed. Global recurrence was 3.7% (28.5% axillary hyperhidrosis group). Compensatory sweating (CS) appeared in 55% and was not related to the extension of the TS. Being female was a predisposing factor of CS (p < 0.004). Excessive dryness appeared at 9% and was associated with extensive TS (P < 0.001). Plantar hyperhidrosis improved at 33.6%, worsened at 10% and remained stable during the follow-up. Satisfaction degree decreased with the passage of time and was associated with recurrence. Quality of life was excellent at discharge, 6 and 12 month in 100%, 100% and 97%, respectively. Conclusions: Pneumothorax is the most frequent complication of TS. CS is the main and undesirable side effect, appears with the passage of time, and is not related to the extension of TS. Being female is the only predictor factor of suffering CS. Plantar hyperhidrosis improves initially, although tends to reappear. Excessive dryness appears in extensive TS and does not improve over time. Postoperative satisfaction degree is high but decreases over time owing to the appearance of recurrence. Effectiveness and the absence of CS determine an excellent quality of life. Six percent of the patients regret the surgery because of severe CS. Informing patients of possible side effects before TS is essential.
European Journal of Cardio-Thoracic Surgery, 2005
Objective: To verify the feasibility and compare the results of thoracoscopic sympathectomy under local anaesthesia (LA) and spontaneous breathing vs. general anaesthesia (GA) with one-lung ventilation. Methods: Two groups of consecutive patients underwent one stage bilateral T2-T3 thoracoscopic sympathectomy under LA (nZ15) and GA (nZ30) by the same surgical team for treatment of primary palmar hyperhidrosis. The groups were homogeneous for relevant demographic, physiological and clinical data, including pulmonary function. In both groups, patient's satisfaction was evaluated 24 h after surgery by a simple interview and scored into five grades (1Zvery poor to 5Zexcellent), while quality of life (QOL) was evaluated by SF-36 and Nottingham's Health Profile questionnaires before and 6 months after surgery. A cost comparison between groups concerning devices, drugs, global in operating room time, medical personnel and hospital stay was also carried out. Results: No operative mortality was recorded. The overall in operating room time for the whole bilateral procedure under LA was 63.55G10.58 vs. 86.05G5.75 under GA (P!0.01) and temperature increased in all patients from a baseline of 25.42G0.56 up to 32.15G0.84 8C. All patients undergone LA were discharged the same day after a chest roentgenogram and a short stay in the outpatient clinic. Among them three patients (20%) experienced a minimal (!30%) pneumothorax that required no treatment, while five (33.3%) had a trunk compensatory sweating that spontaneously resolved on the long run. Patients undergoing GA were discharged after a mean stay of 1.38G0.6 days. Among these, eight (26. 6%) had prolonged trunk compensatory sweating that did not persist longer than 3 months. At a follow-up of 7.16G2.97 months, QOL was significantly improved with no difference between groups. The overall rate of satisfaction was greater in the LA group (P!0.05). Conclusions: In our study, awake one stage bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed as an outpatient procedure in patients refusing GA. Postoperative quality of life was equal to that in patients undergone the same procedure under GA, while patient satisfaction was better and cost were significantly reduced.
Endoscopic Thoracic sympathectomy for Primary Palmar hyperhidrosis
Nepal Journal of Neuroscience
Primary hyperhidrosis is a disorder in which there is an excessive amount of sweating more than required for the body’s thermoregulation. It is due to excessive function of the sudomotor sweat control system in the absence of a sweating trigger. We had a 25-year-old engineer, who presented with complaints of profuse sweating in both his palms, feet and axillae for more than 10 years. He had distressing symptoms disabling his daily activities and causing negative impact in his social, professional, recreational and quality of life. He took medical treatments including topical agents, anticholinergics, iontophoresis and even botulinum toxin injection. All these not only failed to give relief but only aggravated his disappointment. Endoscopic thoracic bilateral sympathectomy was performed from T2 to T4 level. Drastic improvement was seen in immediate post-operative period. Pre-operative palmar temperature of 90° Fahrenheit increased to 96.5° Fahrenheit in immediate post-operative perio...
Surgical Endoscopy, 2007
Background: Thoracoscopic sympathectomy is a useful therapeutic option for palmar hyperhidrosis. Surgeons differ in the level of the sympathetic chain ablated. This study aimed to compare the blockade of the T2 with levels T2 and T3 to verify the effectiveness of different ablation levels in relieving hyperhidrosis symptoms. Methods: For patients undergoing bilateral thoracoscopic sympathectomy for palmar hyperhidrosis, T2-T3 ablation is performed bilaterally. In our series, 25 consecutive patients were blindly randomized to undergo unilateral T2 and T3 ablation followed by contralateral ablation of level T2 only. The patients were followed up and analyzed for comparison of symptoms bilaterally, compensatory hyperhidrosis, and levels of satisfaction postoperatively. Results: The study group consisted of 25 patients with a male:female ratio of 3:2 and a mean age of 32 years (range, 19-50 years). The mean operative time was 35 min. The patients were followed up for a mean period of 23 months (range, 2-65 months). All 25 patients confirmed that their palmar sweating resolved postoperatively, with both palms equally dry. Of the 25 patients, 20 (80%) complained of compensatory hyperhidrosis, which also was bilaterally symmetric. The areas involved were trunk (80%), lower limbs (32%), and armpits (12%). Overall, 80% of the patients were very satisfied with the procedure. The remaining 20% experienced mild to moderate compensatory hyperhidrosis, which did not seem to affect their lifestyle. Conclusion: The findings show that T2 ablation in thoracoscopic sympathectomy for palmar hyperhidrosis is as effective as T2-T3 ablation in terms of symptomatic relief, recurrence, compensatory hyperhidrosis, and patient satisfaction.