One stage bilateral endoscopic sympathectomy under local anesthesia: Is a valid, and safe procedure for treatment of palmer hyperhidrosis?

Abstract

OBJECTIVE:Thoracoscopic sympathetic surgery is currently the best treatment for hyperhidrosis, and the success rate is quite high, but poor emphasis has been given to the type of anaesthesia and its application through either one or two stages of surgery. This study has evaluated the operative and postoperative results of one-stage bilateral thoracoscopic sympathectomy under local anaesthesia.MATERIALS AND METHODS:From 2003 to 2007, n=14 patients with hyperhidrosis of the upper limbs [4 females and 10 males] with a mean age of 28±2.11 year [range 26-44] were included. They were operated on by means of bilateral ETS under local anaesthesia. The mean follow-up was 1.5 years (range 13-24 months).RESULTS:No operative mortality was recorded. The mean operating room time for the whole bilateral procedure under was 73. 5±14.5 range [60 -120] min most of the patients were discharged the same day after a chest roentgenogram except, only two patients with gustatory sweating one recurrent sweating in the patient who had previously axillary hyperhidrosis. Also among them two patients (20%) experienced a minimal pneumothorax that required no treatment. Postoperative quality of life and satisfaction were excellent and cost was significantly reduced.CONCLUSIONS:Bilateral thoracoscopic sympathectomy for palmar hyperhidrosis could be safely and effectively performed in patients refusing GA regarding cost and satisfaction.

Comparison of only T3 and T3-T4 sympathectomy for axillary hyperhidrosis regarding treatment effect and compensatory sweating

“…The best ganglia level for sympathectomy and the optimal technique used to interrupt the sympathetic chain remain the subject of debate. Most authors agree on the use of T3-T4 sympathectomy to treat axillary hyperhidrosis [7][8][9]. Indeed, the results from T3-T4 sympathectomies for the treatment of axillary hyperhidrosis and the subsequent CS have been reported in Table 3: Demographic characteristics, operation durations, patient satisfaction levels, and compensatory sweating and complication incidences of the patients in Group 1 and Group 2 many studies [8,9].…”

“…Hyperhidrosis is defined as a complex dysfunction of the autonomic nervous system that includes excessive sympathetic activity and compensatory parasympathetic activity. The typical treatment approach focuses on decreasing sympathetic activity and promoting parasympathetic activity via a sympathectomy [7][8][9][10]. First-line non-surgical therapies involving topical antiperspirants, such as aluminium chloride, are often short-acting, require frequent reapplication, are ineffective in reducing sweat production, and can cause irritant dermatitis [11].…”