Superiority of Thoracoscopic Sympathectomy over Medical Management for the Palmoplantar Subset of Severe Hyperhidrosis

Baumgartner, Fritz; Bertin, Shana; Konečný, Jan

doi:10.1016/j.avsg.2008.04.014

Cited by 58 publications

(37 citation statements)

References 22 publications

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“…[7][8][9] Different anticholinergic drugs were used to treat hyperhidrosis in the past, but their use did not become routine due to side effects. 10 Oxybutynin is an anticholinergic drug that can be safely used at high doses (over 15 mg/day) to treat patients with urological disorders related to micturition. 11 An effect observed in such patients is diminished sudoresis.…”

Section: Introductionmentioning

confidence: 99%

The use of oxybutynin for treating facial hyperhidrosis

Wolosker

Campos

Kauffman

et al. 2011

An. Bras. Dermatol.

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BACKGROUND: Facial hyperhidrosis is a disease that may lead patients to serious emotional disturbances. Video-assisted thoracic sympathectomy provides excellent resolution of facial hyperhidrosis, but is associated with certain complications. The most frequent and important complication is compensatory hyperhidrosis. Especially in patients who have undergone resection of the second thoracic ganglion, the risk of severe compensatory hyperhidrosis is higher, which may cause dissatisfaction with the procedure. OBJECTIVE: The aim of this study was to evaluate the efficacy of the use of low doses of oxybutynin in treating facial hyperhidrosis as well as the level of patient satisfaction with its use. METHODS: 25 patients with facial hyperhidrosis were treated with oxybutynin. The patients underwent 2 evaluations: before and after treatment. These evaluations were used to assess the patients' clinical improvement and quality of life. RESULTS: We observed that more than 75% of the patients evolved with an improvement in facial hyperhidrosis, and 52% of them presented a great improvement. CONCLUSION: Treatment of facial hyperhidrosis with oxybutynin is a good alternative to sympathectomy, since it presents good results and improves quality of life, in addition to not exposing patients to the risk of experiencing the side effects of sympathectomy. Keywords: Advanced treatment; Clinical protocols; Hyperhidrosis; Indicators of quality of life; Sympathectomy; Sweating Resumo: FUNDAMENTOS: Hiperidrose facial é uma doença que pode levar os pacientes a sérios distúrbios emocionais. A simpatectomia torácica vídeo-assistida proporciona excelente resolução da hiperidrose facial, mas está associada a algumas complicações, sendo a mais freqüente e mais importante a hiperidrose compensatória. Especialmente em pacientes submetidos à ressecção do segundo gânglio torácico, o risco de hiperidrose compensatória grave é maior, o que pode causar insatisfação com o procedimento. OBJETIVO: O objetivo deste estudo foi avaliar a eficácia e a satisfação dos pacientes com o uso da oxibutinina em doses baixas para tratar a hiperidrose facial em uma série grande de pacientes. MÉTODOS: 25 pacientes com hiperidrose facial foram tratados com oxibutinina. Os pacientes foram submetidos a duas avaliações: antes e depois do tratamento. Estas foram usadas para avaliar a melhoria clínica e a qualidade de vida. RESULTADOS: Observou-se que mais de 75% dos pacientes evoluíram com melhora na hiperidrose facial, sendo que 52% deles apresentaram uma grande melhora. CONCLUSÃO: O tratamento da hiperidrose facial com oxibutinina é uma boa alternativa à simpatectomia, visto que apresenta bons resultados e melhora a qualidade de vida, e os pacientes não correm o risco dos efeitos colaterais da simpatectomia.

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Section: Introductionmentioning

confidence: 99%

The use of oxybutynin for treating facial hyperhidrosis

Wolosker

Campos

Kauffman

et al. 2011

An. Bras. Dermatol.

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“…There are many surgical therapies, however, none of them is entirely satisfied in complications and adverse effects (Byrne, Walsh, & Hederman, 1990; Kopelman, Hashmonai, Ehrenreich, Bahous, & Assalia, 1996; Montessi et al., 2007). Nevertheless, transthoracic sympathetic intervention has been proven to achieve a long‐term relief of PH (Ambrogi et al., 2009; Baumgartner, 2008; Baumgartner, Bertin, & Konecny, 2009; Reisfeld & Berliner, 2008). Currently, the optimal therapy for treating PH is the transthoracic endoscopic sympathectomy (TES) (Baumgartner et al., 2009; Kao, 1992; Kao, Tsai, Lai, Hsiao, & Chiu, 1994).…”

Section: Introductionmentioning

confidence: 99%

“…Nevertheless, transthoracic sympathetic intervention has been proven to achieve a long‐term relief of PH (Ambrogi et al., 2009; Baumgartner, 2008; Baumgartner, Bertin, & Konecny, 2009; Reisfeld & Berliner, 2008). Currently, the optimal therapy for treating PH is the transthoracic endoscopic sympathectomy (TES) (Baumgartner et al., 2009; Kao, 1992; Kao, Tsai, Lai, Hsiao, & Chiu, 1994). However, the major side effect of TES is compensatory hyperhidrosis (CH) on the trunk and thighs (Cetindag, Boley, Webb, & Hazelrigg, 2008).…”

Section: Introductionmentioning

confidence: 99%

Pulsed radiofrequency stimulation suppresses palmar hyperhidrosis in an animal study

Lin¹,

Huang

Kao

et al. 2017

Brain and Behavior

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ObjectivesPalmar hyperhidrosis (PH) exhibits excessive and unpredictable sweating. The most effective treatment for permanent cure is the ablation of thoracic sympathetic ganglia innervating hands. However, sympathectomy of T2 sympathetic ganglion by clipping or cauterization causes irreversible nerve damage, and results in a compensatory hyperhidrosis (CH). We herein used the pulsed radiofrequency (PRF) stimulation to reversibly block sympathetic ganglion to treat PH and avoid CH.Material and MethodsA bipolar electrode was implanted into the right T2 sympathetic trunk by endoscopic surgery and PRF was delivered through the electrode. The humidity (%) of right palm was measured to indicate sweating level.ResultsSix out of 13 rats (46.2%) that received a 5‐min PRF stimulation on the T2 sympathetic trunk showed a decrease in the right palm humidity during the surgery. PRF stimulation significantly reduced humidity from 69.17% ± 0.72% obtained from baseline condition to 66.93% ± 0.69%. The humidity reduction was also observed at 10 min after the PRF stimulation. We further evaluated the effect of PRF stimulation 1 week after surgery and found that the PRF stimuli reduced right hand humidity in 5 out of 8 rats (62.5%). PRF stimulation significantly reduced humidity from 66.11% ± 0.81% obtained from sham operation control to 63.62% ± 0.82%. The percentage of right hand humidity obtained 10 min after PRF stimulation was also reduced to 63.38% ± 0.80%. Anesthetics have no effect on humidity.ConclusionsThese results indicate that PRF stimulation of T2 sympathetic trunk reduces palm sweating in rats.

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“…Family history is observed in 12.5 to 56.5 % of the patients [5]. Although local treatment and psychotherapy have been used for palmar hyperhidrosis, the choice of treatment for palmar hyperhidrosis is videoassisted thoracoscopic sympathectomy (VATS) [2,6,7]. Sympathectomy refers to procedures in which the sympathetic chain is resected, ablated, or divided [8].…”

Section: Introductionmentioning

confidence: 99%

Sympathectomy for Palmar Hyperhidrosis

Tülay

2013

Indian J Surg

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Palmar hyperhidrosis is an important situation that may cause emotional and work-related problems. Although local treatment and psychotherapy have been used for palmar hyperhidrosis, the choice of treatment for palmar hyperhidrosis is video-assisted thoracoscopic sympathectomy. Retrospective analysis of 120 bilateral thoracoscopic sympathectomies (60 patients) was done in this study. Earlier, 12 of 60 patients (20 %) had been operated on by other surgeons who used clipping method for palmar hyperhidrosis in different hospitals within 1 year. The procedure was performed under general anesthesia using single-lumen endotracheal tube. Sympathetic chain resection was performed between lower level of the second rib and upper level of the fourth rib. Intercostal blockage at three levels was performed, while thoracoscopic control of the injection sites was done. We observed improvement of symptoms in 95 %, mild compensatory sweating in 20 %, and excessive dryness of hands in 10 % in our patients.

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Superiority of Thoracoscopic Sympathectomy over Medical Management for the Palmoplantar Subset of Severe Hyperhidrosis

Cited by 58 publications

References 22 publications

The use of oxybutynin for treating facial hyperhidrosis

The use of oxybutynin for treating facial hyperhidrosis

Pulsed radiofrequency stimulation suppresses palmar hyperhidrosis in an animal study

Sympathectomy for Palmar Hyperhidrosis

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