Bilateral thoracoscopic sympathectomy: results and long-term follow-up

Abstract

The aim of this study is to evaluate the efficacy of bilateral thoracoscopic sympathectomy in alleviating symptoms and improving quality of life in patients with hyperhidrosis or facial blushing and to investigate the occurrence, severity and possible underlying factors to compensatory sweating after surgery. One hundred and sixty-three patients in a single institution underwent bilateral thoracoscopic sympathectomy with a mean follow-up period of 51 (5-140) months. Indications were for palmar hyperhidrosis (41%), axillary hyperhidrosis (17%), combined palmar and axillary hyperhidrosis (27%) and facial blushing+/-facial hyperhidrosis (15%). Success rates were palmar 98.5%, axillary 96.4%, palmar and axillary 97.7% and facial blushing+/-facial hyperhidrosis 84%. Compensatory sweating occurred in 77% of patients and its severity was related to the severity of the primary complaint. Recurrence rates were palmar 4.6%, axillary 7.4%, palmar and axillary 9.3% and facial blushing+/-facial hyperhidrosis 4.7% at a mean of 22 (3-72) months. An improvement in quality of life was seen in 85% and a diminution of quality of life was noted in 5% due to compensatory sweating. This large mature series demonstrates that bilateral thoracoscopic division of the sympathetic chain as opposed to resection can be performed effectively in patients with success rates higher than 90% and low recurrence rates.

Nonintubated transareolar single-port thoracic sympathicotomy with a needle scope in a series of 85 male patients

“…The results are in line with previous reports of endoscopic thoracic sympathicotomy [20][21][22]. All patients waked up quickly from anesthesia, and none of them complained about sore throat after surgery.…”

Special Considerations for Children with Hyperhidrosis

“…However, botulinum toxin A had a lower incidence of autonomic side effects and pain at the injection site, which likely contributed to its preferential use by most clinicians. 31,32 Botulinum toxin A (Botox; Allergan, Irvine, CA) was approved by the Food and Drug Administration (FDA) in 2004 for the treatment of severe primary axillary hyperhidrosis in adults. Two newer class A botulinum toxins (Dysport; Ipsen Biopharm, Wrexham, UK; Xeomin; Merz Pharmaceuticals Inc, Greensboro, NC) have been approved by the FDA in 2009 and 2011, respectively, for the treatment of other conditions (eg, cervical dystonia) but have not yet received FDA approval for the treatment of hyperhidrosis.…”

Nonintubated Transareolar Endoscopic Thoracic Sympathectomy with a Flexible Endoscope: Experience of 58 Cases

“…The results are in line with previous reports of ETS. 18,19) Drawing on the method of intravenous sedation used for gastroscopy, we used intravenous anesthesia instead of general anesthesia with endotracheal intubation. As we only used fentanyl and propofol, the patients did not experience or remember pain but are capable of breathing on their own during operation.…”