Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

Kocher, Gregor J.; Taha, Anas; Ahler, Markus; Schmid, Ralph A.

doi:10.1007/s00423-014-1249-8

Cited by 17 publications

(9 citation statements)

References 16 publications

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“…In line with this finding, Liu et al compared R3 sympathicotomy an R4 sympathicotomy and found that interruption of the sympathetic chain at R4 does not compromise the therapeutic effect any more than interruption of sympathetic chain at R3 (8). Kocher et al reported that clipping is as effective as transection of the sympathetic chain in the treatment of hyperhidrosis (13). Based on our data, R4 sympathicotomy and R4 sympathetic clipping yielded better results for CS and patient satisfaction when compared to R3 sympathetic clipping.…”

Section: Discussionsupporting

confidence: 57%

“…Thoracoscopic sympathetic surgery is thus regarded as a definitive treatment for palmar hyperhidrosis. Indeed, thoracoscopic sympathetic surgery has lower complication rates irrespective of the method used to interrupt the sympathetic trunk; to date, however, the optimal surgical technique and level of sympathetic trunk interruption in thoracoscopic sympathetic surgery is still debated (5,13). We compared the clinical results by level and type of sympathetic disconnection in patients with palmar hyperhidrosis.…”

Section: Discussionmentioning

confidence: 99%

“…Sympathicotomy that transects the inter-ganglion fibers but does not resect the ganglions is the most popular method worldwide (8). This "R4 only" method is reported to result in high success rates, minimal CS, and less overdryness of the hands (13,18,21).…”

Section: Discussionmentioning

confidence: 99%

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Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

Joo

Lee

Haam³

et al. 2016

J. Thorac. Dis.

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Background: Thoracoscopic sympathetic surgery is regarded as a definitive treatment for palmar hyperhidrosis. However, the optimal surgical strategy remains unclear. The aim of this study was to compare outcomes based on the level and type of sympathetic disconnection in patients with palmar hyperhidrosis. Results: R4 sympathicotomy, R4 sympathetic clipping, and R3 sympathetic clipping were performed in 16, 20, and 23 patients, respectively. The mean degree of palmar sweating after sympathetic surgery was not significantly different between these three groups (17.50% vs. 27.00% vs. 29.78%; P=0.38). The rate of lifebothering compensatory sweating was lower in the R4 sympathicotomy group compared with those of other two groups (0% vs. 25%, 47.8%; P=0.09). The rate of very satisfied to moderate grades of satisfaction were lower in the R3 sympathetic clipping group compared with those of other two groups (93.8%, 100% vs. 73.9%; P=0.07). The rate of recurrence/failure rates were lower in the R4 sympathicotomy group compared with those of other two groups (12.50% vs. 35.00%, 34.8%; P=0.25). Sympathetic surgery at the R3 level was the only significant risk factor for patient dissatisfaction (odd ratio =12.353, 95% confidence interval =1.376-110.914; P=0.025). Conclusions: Our data support that R4 sympathicotomy had lower grades of compensatory sweating, higher grades of satisfaction, and lower rates of recurrence/failure. We therefore consider R4 sympathicotomy as an optimal surgical treatment for palmar hyperhidrosis.

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Section: Discussionsupporting

confidence: 57%

Section: Discussionmentioning

confidence: 99%

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Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

Joo

Lee

Haam³

et al. 2016

J. Thorac. Dis.

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“…The most common and the worst secondary effect of sympathectomy is compensatory sweating mainly involving back, abdomen, and lower limbs. 2 The clipping technique has multiple advantages as It can be performed safely and efficiently. Although clipping is as effective as any other sympathectomy method, but it is potentially reversible if the patient develops severe compensatory sweating.…”

Section: Introductionmentioning

confidence: 99%

Thoracoscopic sympathectomy for treatment of primary hyperhidrosis in children: a randomized comparative study between clipping and electrocautery techniques

Elshahawy

Shamseldin

Akl³

2021

Al-Azhar International Medical Journal

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Background: Hyperhidrosis can be defined as a condition of excessive sweating beyond the body's needs to maintain its temperature within an adequate range. Treatment for primary palmar and axillary hyperhidrosis and facial blushing depends on sympathetic denervation of the affected area which is usually the region innervated by sympathetic ganglia T2, T3, and T4. This can be achieved by sectioning of the sympathetic chain using scissors, electric scalpel, ultrasonic scalpel, or clipping of the chain. Aim of the work:To compare the efficacy between thoracoscopic sympathectomy using metal clips and thoracoscopic sympathectomy using electrocautery as a treatment for primary hyperhidrosis in children to relieve the excessive sweating and improve the patient`s quality of life. Material and Methods: A randomized comparative study on 40 patients suffering from primary hyperhidrosis These patients were allocated randomly into 2 groups. Group (A) was treated by thoracoscopic sympathectomy using clipping technique and group (B) was treated by thoracoscopic sympathectomy using electrocautery technique. Data was tabled and analyzed. Result: A total of 40 patients were enrolled. Success rate among the clipping group was (19/20) 95% and among the electrocautery group was (17/20) 85%, p value was 0.292, compensatory sweating was developed in 11 patients of the clipping group (55%) most of them was of mild to moderate degree and in 11 patients of the electrocautery group (55%) most of them was of mild to moderate degree, p value 0.367. We reversed the procedure in one of our clipping technique patients and showed improvement of the degree of the compensatory hyperhidrosis. Conclusion: Thoracoscopic sympathectomy has been shown to be the most effective treatment for primary hyperhidrosis. Our results showed that clipping technique was as effective as electrocautery technique. Unfortunately, not only the success rates were equal but also the rates of compensatory sweating were found to be similar. The clipping technique offered the advantage of potential reversibility of the procedure in case of severe compensatory hyperhidrosis developed.

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“…[4] However, there is no consensus on the technique to be applied, as cutting, cauterization, or clipping the sympathetic chain or ganglion can yield similar results with regard to the success of the procedure, patient satisfaction, and side effects. [5][6][7][8] The standard intervention is to cut the sympathetic chain by entering from the axilla through two or three ports. Recently, approaches through a transumbilical [9] or trans-areolar incision using a flexible endoscope have been reported for less scar and pain.…”

mentioning

confidence: 99%

The effect of micro-invasive endoscopic thoracic sympathectomy in palmar hyperhidrosis patients on quality of life and hyperhidrosis

Karaçam¹

2017

Turk Gogus Kalp Dama

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Bul gu lar: Ortalama ameliyat süresi 27.5±5.6 dk. idi. Cerrahi başarı oranı %100 idi. Kompansatuar hiperhidrozis oranı altıncı ayda %36.2 idi. Altıncı ayda 45 hastada (%95.7) insizyon yerinde ağrı hissetmez iken, iki hastada (%4.3) hafif ağrı yakınması var idi. Yara yerinde skar oluşumu açısından altıncı ayda 44 hasta (%93.6) yara yerini çok iyi tanımlar iken, üç hasta (%6.4) iyi olarak tanımladı. Ameliyat sonrasında birinci ve altıncı ay Yaşam Kalitesi skorlarında, başlangıç skorlarına kıyasla, istatistiksel olarak anlamlı bir düzelme saptandı (p<0.001).So nuç:Çalışma sonuçlarımız yaş ve semptom süresinin artması ile birlikte kompansatuar hiperhidrozis riskinin ve şiddetinin artığını gösterdi. Çalışma sonuçlarımıza göre, yüksek riskli kompansatuar hiperhidrozisli hastalar ameliyat öncesi analizler ile tespit edilebilir ve düşük hasta memnuniyeti nedeni ile farklı tedavi stratejileri uygulanabilir. Uygun hastalarda, 1 cm'den küçük tek kesi ile yapılan endoskopik torakal sempatektominin minimal ağrı ve skar gelişimi ile ilişkili olduğundan, standart girişim olması gerektiği görüşündeyiz.Anah tar söz cük ler: Endoskopik torakal sempatektomi; hiperhidrozis; mikroinvaziv; yaşam kalitesi. ABSTRACTBackground: This study aims to evaluate the effect of microinvasive endoscopic thoracic sympathectomy in primary palmar hyperhidrosis patients on the quality of life and hyperhidrosis.

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Is clipping the preferable technique to perform sympathicotomy? A retrospective study and review of the literature

Cited by 17 publications

References 16 publications

Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

Comparisons of the clinical outcomes of thoracoscopic sympathetic surgery for palmar hyperhidrosis: R4 sympathicotomy versus R4 sympathetic clipping versus R3 sympathetic clipping

Thoracoscopic sympathectomy for treatment of primary hyperhidrosis in children: a randomized comparative study between clipping and electrocautery techniques

The effect of micro-invasive endoscopic thoracic sympathectomy in palmar hyperhidrosis patients on quality of life and hyperhidrosis

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