Compensatory sweating after thoracoscopic sympathectomy: characteristics, prevalence and influence on patient satisfaction

Abstract

Objective: This prospective study aimed at investigating predictive factors for compensatory sweating after thoracoscopic sympathectomy. Methods: From 2000 to 2002, 80 patients (53 females and 27 males) underwent thoracoscopic sympathectomy to treat hyperhidrosis. Patient ages ranged from 12 to 56 years, and the mean postoperative follow-up period was 42.51 ± 5.98 months. Patient satisfaction with the results was evaluated through the use of a rating scale. The procedure was performed bilaterally: at the T2 level for facial hyperhidrosis; at the T3-T4 level for axillary hyperhidrosis; and at the T3 level for palmar hyperhidrosis. Results: Post-operatively, 68 patients (85.0%) presented compensatory sweating, which was classified as mild in 23 (33.8%), moderate in 23 (33.8%) and severe in 22 (32.4%). Considering the final surgical results, 70 patients (87.5%) were satisfied with the outcome of the operation, whereas 10 patients (12.5%) were dissatisfied. The level of patient satisfaction varied according to gender, age, body mass index (BMI) and extent of denervation. The compensatory sweating was more severe on the abdomen and back than on the legs. Conclusions: Although compensatory sweating, which is a common adverse effect of sympathectomy, occurred in the majority of cases, the level of patient satisfaction was high. The best candidates for thoracoscopic sympathectomy are young adult women with a BMI ≤ 24.9 kg/m 2 .Keywords: Sympathectomy; Hyperhidrosis; Thoracoscopy; Postoperative complications; Thoracic surgery, video-assisted. ResumoObjetivo: Este estudo prospectivo visou investigar fatores preditivos para a hiperidrose compensatória após a simpatectomia toracoscópica. Métodos: De 2000 a 2002, 80 pacientes (53 mulheres e 27 homens), com idade entre 12 e 56 anos, foram submetidos à simpatectomia toracoscópica para o tratamento de hiperidrose e acompanhados em média por 42,51 ± 5,98 meses. A satisfação destes pacientes quanto aos resultados do procedimento foi aferida por meio de uma escala de avaliação. O procedimento foi executado bilateralmente: no nível de T2 para a hiperidrose facial; de T3 e T4 para a hiperidrose axilar; e de T3 para a hiperidrose palmar. Resultados: No período pós-operatório, 68 pacientes (85,0%) apresentaram hiperidrose compensatória, que foi classificada como leve em 23 (33,85%), moderada em 23 (33,8%) e grave em 22 (32,4%). Quanto aos resultados da cirurgia, na avaliação dos pacientes, 70 deles (87,5%) se consideraram satisfeitos, enquanto 10 pacientes (12,5%) disseram estar insatisfeitos. O grau de satisfação do paciente variou de acordo com o sexo, a idade, o índice de massa corpórea (IMC) e a extensão da operação. A hiperidrose compensatória foi mais intensa no abdome e dorso do que nas pernas. Conclusões: Embora a hiperidrose compensatória seja um efeito adverso frequente após a simpatectomia, o grau de satisfação dos pacientes foi elevado. Os melhores candidatos para simpatectomia toracoscópica são mulheres adultas jovens com IMC ≤ 24,9 kg/m 2 .

An alternative to treat palmar hyperhidrosis: use of oxybutynin

“…Our patients were in their early twenties. Most of the patients undergoing operations were females, and likewise, we observed that the patients undergoing oxybutynin treatment were also predominantly females; this was probably because excessive sweating has greater repercussions in the day-to-day lives of women [19].…”

The use of oxybutynin for treating facial hyperhidrosis

“…There is no female predominance as seen in other sites of hyperhidrosis, probably because this type of excessive sweating has greater repercussions in men's daily lives than in women's. 21 Patients using oxybutynin to treat urinary disorders take larger doses (15 mg/day) and may present more severe side effects (dry mouth, headache, and urine retention). 22 However, we did not observe this with the low and progressive doses used in the present study.…”

Diagnosis and Treatment of Primary Hyperhidrosis

“…Despite undoubted therapeutic success in surgical treatment of primary hyperhidrosis using sympathectomy procedure, some patients who have undergone this form of treatment suffer from long-term side effects (73,74,75). This is particularly important in the light of the fact that the goal of hyperhidrosis treatment is improvement of life quality.…”

“…It occurs in 0-95% of patients (20,51,62,63,73,74,75). Large discrepancy in the results is related to lack of precise definition of compensatory sweating.…”

“…Excessive sweating of torso in response to thermal stimuli and/or related to physical activity does not meet the reductionist definition of compensatory sweating. This side effect of thoracic sympathectomy can be divided into mild, moderate and severe (74,75).…”