CT-Assisted Sympathicolysis as an Additional Minimally Invasive Therapeutic Option in Primary Focal Plantar Hyperhidrosis

Scheer, F; Wiggermann, P; Kamusella, P; Wissgott, Christian; Andresen, Reimer

doi:10.1007/s00270-013-0824-7

Cited by 7 publications

(6 citation statements)

References 21 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…6,16,18 There was a variation from 7.5 to 90% CS after mechanical sympathectomy and from 1.5 to 34% after chemical sympathicolysis; since there is no standardization in the questioning of this complication, it is suggested the possibility of underreporting of its presence. All studies performed lumbar sympathectomy after TS, a surgical procedure with 16 Satisfaction rate 37 months Reisfeld et al 17 -24 months Rieger et al 18 Satisfaction rate 24 months Kim et al 19 Satisfaction rate 14.3 months average Loureiro et al 20 QoL 15 Chemical sympathicolysis L3/L4 35 6 1 Rieger et al 16 Mechanical sympathectomy L2/L3/L4 96 --Reisfeld et al 17 Mechanical sympathectomy L3/L4 * L2 63 11 0 Rieger et al 18 Mechanical sympathectomy L3/L4 90 38 3 Kim et al 19 Chemical sympathicolysis L3 to L5 69 3 1 Loureiro et al 20 Mechanical (2015) Yun (2017) 441 405 τ 2 = 0.00; χ 2 = 3.24, df = 6 (P = 0.78); I 2 = 0% Z = 3.07 (P = 0.002) Heterogeneity:…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis

et al. 2019

View full text Add to dashboard Cite

Results There were no deaths, and the resolution of symptoms of primary plantar hyperhidrosis (PPH) occurred in 92% of patients after mechanical sympathectomy. A total of 177 patients (44%) were reported to have mild to severe compensatory sweating after a mean 6 months follow-up. The preservation of L2 did not interfere with the primary outcome, and it is possible to perform lumbar sympathectomy in men with L2 preservation, achieving satisfactory cure results of PPH, minimizing the risk of sexual dysfunction. There were no deaths, and the resolution of symptoms of PPH occurred in 10% of patients after chemical sympathicolysis after a mean 6 months follow-up. A total of 13 patients (12.5%) were reported to have mild to severe compensatory sweating using the same technique. ConclusionThe mechanical lumbar sympathectomy is effective and safe and improves quality of life, evaluated by the high symptom resolution of PPH and low rate of complications. The chemical sympathicolysis in the immediate postoperative period presented satisfactory results; however, it was shown to be significantly less effective than the mechanical approach in a follow-up of at least 6 months.

show abstract

Section: Discussionmentioning

confidence: 99%

A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis

et al. 2019

View full text Add to dashboard Cite

show abstract

“…The needle was then withdrawn, and the patient was maintained in the supine position for 4 hours, while the pulse, blood pressure, and respiration were monitored. [6][7][8][9][10]15 Evaluation of the Severity of Palmar Hyperhidrosis…”

Section: Botulinum Toxin Type a Injectionmentioning

confidence: 99%

“…Thoracic sympathectomy is considered the best treatment, and is adopted by the majority of thoracic surgical centers worldwide because of its safety and ability to achieve a definitive cure. [6][7][8][9][10] However, BTX-A injection is a promising new therapeutic option for palmar hyperhidrosis that is administered on an outpatient basis, and has minimal adverse reactions, low invasiveness, and high efficacy. [11][12][13] The present retrospective, observational study was a comparative analysis of patients with palmar hyperhidrosis who underwent either thoracic sympathectomy or BTX-A injection.…”

Section: Introductionmentioning

confidence: 99%

CT-Guided Chemical Thoracic Sympathectomy versus Botulinum Toxin Type A Injection for Palmar Hyperhidrosis

Yang

Kang

Zhang

et al. 2018

Thorac cardiovasc Surg

View full text Add to dashboard Cite

show abstract

“…The DLQI was identified in studies conducted globally, including in the UK (n = 9 103,232,261,262,267,268,275 ), the USA and Canada (n = 8 77,107,139,173,176,208,222,263 ), Italy (n = 7 101,102,106,214,223,266,272 ), Germany (n = 5 69,158,227,270,271 ), Sweden (n = 4 114,116,117,128 ), Greece (n = 3 [119][120][121] ), Ireland (n = 2 265,274 ), Iran (n = 2 170,264 ), Spain (n = 2 210,230 ), Australia (n = 1 ) or surgical reviews or reviews of surgery compared with dermatology (n = 3 147,267,273 ). The DLQI was used in studies to measure quality of life on various areas of the body; studies of axillary sweating combined with other parts of the body, such as palms or feet, were most common (n = 26 54,56,69,77,101,103,106,107,…”

Section: Review Of Quality-of-life Measures/toolsmentioning

confidence: 99%

“…The DLQI was used in studies to measure quality of life on various areas of the body; studies of axillary sweating combined with other parts of the body, such as palms or feet, were most common (n = 26 54,56,69,77,101,103,106,107,114,[119][120][121]139,147,158,170,173,176,214,221,223,263,266,273,274 ). Studies were identified of the palm or palm and foot combined (n = 11 61,128,208,222,230,264,265,[269][270][271][272] ) and of other combinations including the face, palm and/or foot or generalised hyperhidrosis (n = 11 116,117,210,217,227,232,261,262,267,268,275 ).…”

Section: Review Of Quality-of-life Measures/toolsmentioning

confidence: 99%

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Wade

Rice

Llewellyn

et al. 2017

Health Technol Assess

View full text Add to dashboard Cite

BackgroundHyperhidrosis is uncontrollable excessive sweating that occurs at rest, regardless of temperature. The symptoms of hyperhidrosis can significantly affect quality of life. The management of hyperhidrosis is uncertain and variable.ObjectiveTo establish the expected value of undertaking additional research to determine the most effective interventions for the management of refractory primary hyperhidrosis in secondary care.MethodsA systematic review and economic model, including a value-of-information (VOI) analysis. Treatments to be prescribed by dermatologists and minor surgical treatments for hyperhidrosis of the hands, feet and axillae were reviewed; as endoscopic thoracic sympathectomy (ETS) is incontestably an end-of-line treatment, it was not reviewed further. Fifteen databases (e.g. CENTRAL, PubMed and PsycINFO), conference proceedings and trial registers were searched from inception to July 2016. Systematic review methods were followed. Pairwise meta-analyses were conducted for comparisons between botulinum toxin (BTX) injections and placebo for axillary hyperhidrosis, but otherwise, owing to evidence limitations, data were synthesised narratively. A decision-analytic model assessed the cost-effectiveness and VOI of five treatments (iontophoresis, medication, BTX, curettage, ETS) in 64 different sequences for axillary hyperhidrosis only.Results and conclusionsFifty studies were included in the effectiveness review: 32 randomised controlled trials (RCTs), 17 non-RCTs and one large prospective case series. Most studies were small, rated as having a high risk of bias and poorly reported. The interventions assessed in the review were iontophoresis, BTX, anticholinergic medications, curettage and newer energy-based technologies that damage the sweat gland (e.g. laser, microwave). There is moderate-quality evidence of a large statistically significant effect of BTX on axillary hyperhidrosis symptoms, compared with placebo. There was weak but consistent evidence for iontophoresis for palmar hyperhidrosis. Evidence for other interventions was of low or very low quality. For axillary hyperhidrosis cost-effectiveness results indicated that iontophoresis, BTX, medication, curettage and ETS was the most cost-effective sequence (probability 0.8), with an incremental cost-effectiveness ratio of £9304 per quality-adjusted life-year. Uncertainty associated with study bias was not reflected in the economic results. Patients and clinicians attending an end-of-project workshop were satisfied with the sequence of treatments for axillary hyperhidrosis identified as being cost-effective. All patient advisors considered that the Hyperhidrosis Quality of Life Index was superior to other tools commonly used in hyperhidrosis research for assessing quality of life.LimitationsThe evidence for the clinical effectiveness and safety of second-line treatments for primary hyperhidrosis is limited. This meant that there was insufficient evidence to draw conclusions for most interventions assessed and the cost-effectiveness analysis was restricted to hyperhidrosis of the axilla.Future workBased on anecdotal evidence and inference from evidence for the axillae, participants agreed that a trial of BTX (with anaesthesia) compared with iontophoresis for palmar hyperhidrosis would be most useful. The VOI analysis indicates that further research into the effectiveness of existing medications might be worthwhile, but it is unclear that such trials are of clinical importance. Research that established a robust estimate of the annual incidence of axillary hyperhidrosis in the UK population would reduce the uncertainty in future VOI analyses.Study registrationThis study is registered as PROSPERO CRD42015027803.FundingThe National Institute for Health Research Health Technology Assessment programme.

show abstract

CT-Assisted Sympathicolysis as an Additional Minimally Invasive Therapeutic Option in Primary Focal Plantar Hyperhidrosis

Abstract: After conservative measures have been exhausted or as a complement to the existing therapy regimen, CT-assisted sympathicolysis represents a therapeutic option low in side effects that provides a marked benefit to patients with primary, focal hyperhidrosis.

Cited by 7 publications

References 21 publications

A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis

A systematic review and meta‐analysis to evaluate the efficacy of lumbar sympathectomy for plantar hyperhidrosis

CT-Guided Chemical Thoracic Sympathectomy versus Botulinum Toxin Type A Injection for Palmar Hyperhidrosis

Interventions for hyperhidrosis in secondary care: a systematic review and value-of-information analysis

Contact Info

Product

Resources

About