Endoscopic Thoracic Sympathectomy for Primary Hyperhidrosis of the Upper Limbs A Critical Analysis and Long-Term Results of 480 Operations

Abstract

ObjectiveThis evaluated the long-term outcome after endoscopic thoracic sympathectomy (ETS) from below Dl to D4, using a single-site access technique for primary hyperhidrosis of the upper limbs. Summary Background DataPrimary hyperhidrosis of the upper limbs is a distressing and often socially disabling condition. Endoscopic thoracic sympathectomy is considered the treatment of choice, causing minimal morbidity and high initial success rates. However, data regarding long-term results are scarce. MethodsTwo hundred seventy of 323 patients (83.7%), in whom 480 sympathectomies were performed, answered a questionnaire after a mean of 14.6 years postoperatively regarding the early postoperative result, side effects, and complications caused by the operation and long-term results with particular emphasis on patient satisfaction. ResultsThere was no postoperative mortality and no major complications requiring surgical reintervention. A majority of the patients (98.1 %) were relieved, and 95.5% were satisfied initially. Permanent side effects included compensatory sweating in 67.4%, gustatory sweating in 50.7% and Horner's trias in 2.5%. However, patient satisfaction declined over time, although only 1.5% recurred. This left only 66.7% satisfied, and a 26.7% partially satisfied. Compensatory and gustatory sweating were the most frequently stated reasons for dissatisfaction. Individuals operated for axillary hyperhidrosis without palmar involvement were significantly less satisfied (33.3% and 46.2%, respectively).

Minimally invasive video-endoscopic sympathectomy by use of a transaxillary single port approach

“…Although some authors have advocated the use of 2-and 3-mm trocars, no discomfort and neuralgia sequelae were encountered in our series. Complications occurred in 6.5% of the sympathectomies, which is comparable to other reports [11], but no conversion to open surgery was required in our series. The development of a residual mantle pneumothorax after endoscopic thoracic operations is a well-known complication and is not specific to this procedure per se [1,11,14].…”

“…Complications occurred in 6.5% of the sympathectomies, which is comparable to other reports [11], but no conversion to open surgery was required in our series. The development of a residual mantle pneumothorax after endoscopic thoracic operations is a well-known complication and is not specific to this procedure per se [1,11,14]. Horner's syndrome was observed in 2.7% of the procedures, which corresponds to the data in the literature [11], but the symptomatology was transient in both patients, with complete recovery after 14 and 18 weeks, respectively.…”

“…The development of a residual mantle pneumothorax after endoscopic thoracic operations is a well-known complication and is not specific to this procedure per se [1,11,14]. Horner's syndrome was observed in 2.7% of the procedures, which corresponds to the data in the literature [11], but the symptomatology was transient in both patients, with complete recovery after 14 and 18 weeks, respectively. Both transient Horner's syndromes were probably related to thermic injury of the stellate ganglion during division of the chain on the second rib.…”

Simpatectomía toracoscópica: una revisión de la literatura

“…El sistema nervioso simpático tiene una gran capacidad de regeneración y de crecimiento, por lo que es posible la aparición de recidivas incluso después de un año 28 .…”

“…Habitualmente su causa es desconocida (idiopática) y se estima una incidencia inferior al 1%, siendo mayor en Estados Unidos (2.8%) y poblaciones asiáticas (4-5%) 2,11,55,59,82 . En un 70% o más de los casos se inicia en la niñez y en un 16-20% en la adolescencia, siendo poco frecuente su comienzo en adultos 28,46,62,72 . Tiene un discreto predominio femenino 46 y en un 25-65% de los casos existen otros familiares afectados (variante familiar), de forma que se ha propuesto una herencia con penetrancia variable 68 .…”