Reoperation for Essential Hyperhidrosis

Abstract

Palmar hyperhidrosis has a recurrence rate of 0% to 5% after thoracic sympathectomy. From January 1992 to October 1997, thoracic sympathectomy was performed by video-assisted thoracoscopic surgery for hyperhidrosis in 490 patients of whom 5 (2 male and 3 female with a mean age of 20 years) experienced recurrent hyperhidrosis in the early (< 7 days) or late (up to 6 months) postoperative period. All patients had moderate to severe pleural adhesions in the previous sympathectomy sites but no operative complications or crossover to thoracotomy occurred. Surgery resulted in satisfactory outcomes showing that video-assisted thoracoscopic sympathectomy was effective in treating recurrent hyperhidrosis. Prevention of recurrence requires the identification and resection of the second thoracic sympathetic ganglion as well as the Kuntz fibers.

Diretrizes para a prevenção, diagnóstico e tratamento da hiperidrose compensatória

“…(21,22) However, in patients submitted to sympathetic blockage by clipping of the sympathetic chains, there is the possibility of a second surgery to remove the metallic clip, aiming at nerve regeneration in cases that develop CH. (23) The current clips have a pressure of approximately 150 g, and nerve transmission can be interrupted by compression greater than 44 g without the necessity of sectioning the nerve.…”

Surgical Management of Primary Upper Limb Hyperhidrosis – A Review

“…But unsatisfactory immediate results can occasionally be detected (de Campos et al, 2003). Causes for persistent postoperative sweating are inadequate knowledge and orientation of the surgeon or unrecognised variances of anatomic structures (D.H. Kim et al, 2005;Reisfeld et al, 2002;Yoon et al, 1999) including Kuntz nerve, a communicating sympathetic ramus crossing the second rib (Chung et al, 2002) (Fig. 9).…”

“…Therefore some authors recommend extension of the sympathectomy line to about three or five centimetres lateral to the sympathetic chain by coagulating the surface of the corresponding rib, a method first described by Linder andcolleagues in 1994 (Linder et al, 1994). Adequacy of sympathectomy is also tried to be detected by perioperative use of monitoring device like measuring skin surface temperature or plethysmographic blood flow (Lee et al, 1999;Yoon et al, 1999). Long-term outcomes of more than 10 years are rarely reported (Zacherl et al, 1998).…”