Long-term follow-up in quality of life before and after endoscopic thoracic sympathicotomy in 367 patients with palmar hyperhidrosis

Abstract

Background: Palmar hyperhidrosis (PH) hinders daily activities and deteriorates quality of life (QOL).Endoscopic thoracic sympathicotomy (ETS) is safe and efficient as the gold standard treatment for PH.So far, the long-term change of QOL after surgery has not been fully characterized, which is important to evaluate clinical benefits and helped to identify the true beneficiaries. In the current study, we aimed to investigate the long-term outcome of ETS by comparing their preoperative QOL with a follow-up QOL. Methods: This study enrolled 367 patients with PH who underwent ETS between March 2018 and March 2019. All patients were surveyed by a web-based questionnaire adapted from de Campos Quality-of-life Questionnaire for Evaluation of Hyperhidrosis, and compared to their preoperative results. Results: After a median follow-up of 14 months [interquartile range (IQR), 9-21 months], improvement in QOL was reported in 90.7% of patients. Compared to preoperative QOL [median (Md) =40, IQR, 37-45],postoperative QOL was significantly improved (Md =20, IQR, 13-23; P<0.001). A higher QOL score was noticed in patients with severer PH at diagnosis, whereas no significant difference was observed among postoperative QOL regarding the severity of PH. Subclinical compensatory hyperhidrosis (CH) occurred in 94.6% of post-ETS cases after long-term follow-up. The score of postoperative QOL was significantly positively correlated to the severity of CH (rs=0.14; P=0.009).Conclusions: Improvement in QOL sustained for a long-term period after receiving ETS for PH. Almost all patients developed subclinical CH on other body sites in the long run, with an impairment in QOL correlating with the severity of CH. Further investigations on the developing patterns of CH and clinical coping strategy are warranted to improve the long-term outcome of ETS.

The Impact of Hyperhidrosis on Quality of Life: A Review of the Literature

“…Several studies show that HH treatments decrease sweat production and improve psychosocial symptoms. Sympathectomy was found to improve social esteem [ 15 ] and emotional scores as per the Hyperhidrosis Quality of Life Questionnaire (HQLQ) [ 16 ], a tool that scores QoL from one to five in four domains (functional, personal life, emotional self, and special circumstances) [ 17 – 22 ]. However, for patients undergoing thoracic sympathectomy, reflex sweating also known as compensatory HH may develop and has been associated with anxiety although overall patient satisfaction was preserved [ 11 ].…”

“… Hur et al 2022 [ 21 ] HQLQ Pre-post interventional study 30 Mean pre-sympathectomy QoL score for patients with plantar HH was 91.8 (“very bad” QoL), and the postoperative 12 months (QoL) score improved to 29.1 (“much better” QoL). Zhang et al 2022 [ 22 ] HQLQ Pre-post interventional study 367 Median pre-sympathectomy QoL score for patients with plantar HH was 40, and postoperative 12 months (QoL) score improved to 20. Gong et al 2013 [ 23 ] Beck Depression Inventory, Beck Anxiety Inventory Pre-post interventional study 19 Patients with CH had reduced anxiety and depression after treatment with oral glycopyrrolate.…”

Innovative approaches to neutralizing sympathetic nerves in addressing focal hyperhidrosis

“…For instance, it has been found to be 2.8% in the USA [5,3]. There is literature support for the possibility of a genetic transmission of hyperhidrosis, and it is particularly thought to be possibly associated with the 14th chromosome [6]. Pathophysiology Sweating is a mechanism that maintains the body's thermal equilibrium.…”