The Society of Thoracic Surgeons Expert Consensus for the Surgical Treatment of Hyperhidrosis (original) (raw)
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Thoracoscopic Sympathectomy for Hyperhidrosis
OAlib, 2020
The aim of the study: The goal of this retrospective study was to evaluate the outcomes of bilateral thoracoscopic sympathectomy for primary hyperhidrosis. Methods: We identified all patients who underwent bilateral thoracoscopic sympathectomy between January 2017 and May 2020, in Sana'a (capital of YEMEN) hospitals. Details of pre-operative symptoms, surgical procedure and post-operative complications were collected from the patient's files, and each patient was sent a questionnaire regarding success of the procedure, and compensatory sweating through their phone number by what Sapp. Results: We had 36 patients complaining of hyperhidrosis: 27 cases were males and 9 cases were females, age range 14-32 years at the time of surgery. All of them suffered from hyperhidrosis in the palm and sole, 15 cases of them suffered from hyperhidrosis in axilla, and 10 cases of patients were associated with facial blushing. All cases improved from sweat in the palm (100%), and most of them improved from the sweat of sole (94.6%). Conclusion: Thoracoscopic sympathectomy is effective in the treatment of hyperhidrosis. However, compensatory hyperhidrosis seems unavoidable complication and infrequently improves with time, so patients should be clearly informed before committing to surgery.
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.
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.
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...
Serbian Journal of Dermatology and Venerology, 2010
Primary hyperhidrosis affects approximately 3% of the world's population, particularly young female adults. It is defined as excessive, profuse sweating of the palms, soles, armpits and face. Conservative treament includes diverse modalities, however, surgical treatment has shown the best long-term results. The objective of this study was to assess some disease-specific epidemiological characteristics in a pre-selected group of patients seeking surgical therapy, as well as outcomes of thoracoscopic sympathectomy. The severity and impact of hypehidrosis was assessed, using Hyperhidrosis Disease Severity Scale (HDSS: patients rate the serverity of symptoms on a scale from 1 to 4). Thoracoscopic sympathectomy was performed using a double lumen endotracheal tube, via bilateral 5 mm dual port videothoracoscopic camera 0°, and an endoscopic ultrasound activated harmonic scalpel. The sympathetic chain was resected on both sides at the level of the second and the third thoracic ganglion (T2 and T3), using an ultrasound knife. The extirpated chain was also at the level T3-T4 and sent for ex tempore analysis. There were 162 patients undergoing thoracoscopic sympathectomy: 39.51% were males and 60.49% females; at presentation their mean age (± SD) was 30.5 (±8.3), range 16 -58 years. Axillary hyperhidrosis occurs later than palmar-axillary-plantar (p<0.05). A total of 35.18% of the evaluated patients were able to name at least one member of their families who also suffered from hyperhidrosis. The most commonly affected area was palmar-axillary-plantar (30.25%). Fifty patients (30.86%) received conservative therapy before surgery. The most commonly used conservative therapy modalities included different kinds of ointments/tinctures (11.73%), botox (8.02%) and iontophoresis (2.47%). Prior to surgery, 91.36% of patients reported severe sweating (HDSS score 3 or 4). The highest mean score was given for a combination of facial-palmar-axillaryplantar hyperhidrosis (3.80±0.24). All surgeries were successfully performed, with no complications, or perioperative morbidity. The mean hospital stay was 1.28±0.68 days long. After surgery, 93.21% of patients reported mild or moderate hyperhidrosis (HDSS score 1 or 2). Compensatory sweating (lower part of the back, and abdomen) was reported by 34.57% of patients after the surgery. All patients had a 6-months long follow-up: a significant improvement in quality of life was reported by 84.56% of patients (Yates corrected c 2 (1) = 228.42; p=0.0000)); due to compensatory sweating, only 4.94% and 1.85% of patients reported bad and very bad quality of life, respectively. In conclusion, nowadays videothoracoscopic sympathectomy is a standard treatment for primary hyperhidrosis with a high success rate.
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
Stratified Analysis of Clinical Outcomes in Thoracoscopic Sympathicotomy for Hyperhidrosis
The Annals of Thoracic Surgery, 2008
Background. The primary goal of this study is to identify clinical variables associated with successful surgical treatment for hyperhidrosis and facial blushing. Methods. Six hundred eight thoracoscopic sympathicotomies were performed in 304 patients. Retrospective stratified analysis of patients after thoracoscopic sympathicotomy for hyperhidrosis or facial blushing and having completed follow-up of at least 6 months (n ؍ 232) was performed. Preoperative and postoperative qualityof-life indices (range, 0 to 3) were used to measure impact of surgery, and comparisons were indexed to preoperative symptoms. Postoperative compensatory sweating was analyzed with respect to the level(s) of sympathetic chain division. Results. Thoracoscopic sympathicotomy was performed at level T2 alone in 5% of patients; levels T2 to T3 in 63% of patients; levels T3 to T4 in 3% of patients; levels T2 to T4 in 14% of patients; and more than three levels in 14% of patients. In hyperhidrosis patients, mean preoperative quality-of-life index was 2.0 and postoperative quality-of-life index was 0.4 (p < 0.001). Facial blushers had preoperative and postoperative quality-of-life index of 2.6 and 1.0, respectively. Significant compensatory sweating was seen in 33% patients overall and occurred in 29% of patients with palmar symptoms, 26% of axillary patients, and 42% of facial blushers. Significant compensatory sweating in relation to the level(s) of sympathetic chain division occurred in T2 alone, 45%; T2 to T3, 30%; T3 to T4, 14%; T2 to T4, 38%; and more than three levels, 49%. Conclusions. Significant improvement in quality of life can result from surgery for hyperhidrosis. However, the incidence of postoperative compensatory sweating may be dependent on the level of sympathicotomy performed. The choice of sympathicotomy level(s) should be directed toward reducing the incidence of significant compensatory sweating while simultaneously ensuring relief of primary preoperative symptoms.